IS 2024 Benefits Realization Analysis by Penn Medicine Information Services

INFORMATION SERVICES

BENEFITS REALIZATION ANALYSIS

STATE OF INFORMATION SERVICES

SUPPLEMENT

PURPOSE OF THE REPORT

The 2024 Penn Medicine Information Services Benefits Realization report reviews forty-eight (48) high-profile, high-quality projects implemented in fiscal years 2022 and 2023. The Penn Medicine Information Services (IS) team collaborated with operational and clinical partners to generate substantial financial and qualitative benefits featured in this year’s report. The projects are grouped into five categories that define key strategic goals of Penn Medicine: Empowering Technologies, Digitally Enabled Healthcare, Making Data Meaningful, Making the Connection, and Research. In this edition, there is also a Transformational Technologies section which highlights emerging trends from across the healthcare sector, providing valuable context for how Penn Medicine is positioning itself in response to these changes.

The mission of Information Services is to transform data into value to support our caregivers, business administrators, and patients. During fiscal years 2022 and 2023, IS initiated thousands of projects in support of this mission. As projects are completed, Penn Medicine has realized substantial value from the investments of time, resources, and empowering technology in terms of:

• Quality patient care and safety.

• Patient, family, staff, and physician satisfaction with the care and services provided.

• Education and research support.

Furthermore, direct patient care value was realized from IS support, as many of these projects feature measured and evaluated financial and qualitative returns derived from these investments.

Over the past 13 years, Penn Medicine has undergone a significant transformation in its use of technology, steadily advancing its capabilities to improve healthcare delivery. Information Services’ journey has moved through distinct phases, each building on the last, as technology became increasingly essential to the organization’s ability to provide innovative, data-driven care.

In the first stage, the focus was on establishing a strong foundation by implementing common electronic health records and standardizing processes across the system. This set the stage for the next phase, where meaningful use of data began to play a more central role. Tools such as dashboards and early warning systems allowed clinicians to make better decisions in real time, and the integration of research and clinical data became more seamless. As advancements continued, Penn Medicine moved into precision medicine, where genomic and phenotype data were integrated to deliver more personalized treatments. Mobility capabilities also expanded, ensuring that data was accessible anytime, anywhere. Currently, the focus has evolved to artificial intelligence and innovation, where vast amounts of data are being used to create predictive models and drive new approaches to care.

Looking ahead, Information Services remains at the forefront in contributing to healthcare transformation at Penn Medicine. As the institution moves into the era of AI-driven care, technology is no longer just a tool but a backbone to providing healthcare. In this rapidly changing landscape, technology is the business driver that allows the organization to continuously evolve with new capabilities and brings increased efficiencies and economies of scale. The advancement of Information Services over the years, and the subsequent stories included in this report, demonstrate how technology is now indispensable, powering the future of healthcare innovation.

Penn Medicine’s core mission of world class patient care, education, and research is the primary focus of the Information Services team. This mission has never been more critical than over these past two years, as healthcare is being redefined after the impact of the global pandemic along with the emergence of key factors driving industry growth such as the rising demand in remote patient monitoring, advancement of healthcare IT infrastructure, and continued investments in eHealth and digital health.

This report highlights key projects from fiscal years 2022 and 2023 that have driven significant operational savings, future cost avoidance, additional revenue, and qualitative improvements. Reflecting on the incredible progress made by Penn Medicine’s IS team over the past two years, we are inspired to continue to build upon these accomplishments.

The successes detailed in this report reinforces the teamwork, dedication, and commitment that defines the Penn Medicine culture. We are proud to showcase a selection of projects that have advanced operational, financial, and clinical outcomes to new heights. In collaboration with leadership, the IS team has made significant strides in core operations, supported growth strategies, addressed evolving consumer needs, and expanded our research capabilities through the development of innovative solutions.

We have fully embraced a new era of technological innovation, supporting new research initiatives in cancer interception and immune health, while leveraging artificial intelligence and machine learning to deliver faster and deeper insights for improving operational efficiency, clinical outcomes, and research. Our teams have embraced these advances and gained global recognition while always prioritizing the patient and those who care for them.

We extend our deepest gratitude to our colleagues, whose remarkable efforts have laid the foundation for Penn Medicine to thrive in this evolving healthcare industry.

MAKING THE CONNECTION

COMPLETE REVIEW OF FINANCIAL IMPACT

DIGITALLY ENABLED HEALTHCARE

Medicine at Home Merger Expands Home Care Services, Integrated Technology Aligns Care

First in the World, Next Generation Proton Therapy Supported by State-of-the-Art Technology

Pioneering CAR-T at Lancaster General Health, Delivering Groundbreaking Outpatient Cancer

LiveAware Platform Uses Natural Language Processing to Improve Clinical Outcomes for Hepatocellular Carcinoma (HCC)

Lancaster General Health Food Farmacy Program Raises Nutrition Based Population Health Outcomes

Patient Statin Adherence Improved by Leveraging New Technology Features

BREAKDOWN OF SAVINGS

DIGITALLY ENABLED HEALTHCARE

EMPOWERING TECHNOLOGIES

These projects are focused on technologies and processes to address the administrative and physical infrastructure that includes financial services, operations, human resources, managed care, contracting, billing, materials management and others.

TOTAL FINANCIAL IMPACT: $54,538,366

These projects are focused on implementation and enhancement of the Electronic Medical Records applications in which clinical documentation is captured and used to support patient care delivery. Mobile Health and Patient Engagement tools are also represented.

These projects are focused on using

MAKING DATA MEANINGFUL

These projects are focused on effective capture and use of data from the clinical and financial systems to support improved care delivery, financial management and quality improvement.

$12,972,937

$26,666,520

$37,006,104

PROJECTS

Penn Medicine at Home Merger Expands Home Care Services, Integrated Technology Aligns Care

First In The World, Next Generation Proton Therapy Supported By State Of The Art Technology

Technology Outfitted to Support New Gift of Life Donor Center

340B Medication Management Clinic Implementation

Pioneering CAR-T at Lancaster General Health, Delivering Groundbreaking Outpatient Cancer Therapy

New High Sensitivity Troponin BioMarker Standard Leads to Better Precision Patient Care

Specialty Injections Pharmacy Designed to Help Facilitate Patient Care Continuity

Princeton Medical Center Lab Integration with Enterprise System

Enhancements to the ICU Board Improve Clinical Workflow and Prompts Patient Centered Care

A Focus on Physician Wellness, Using Technology to Reduce EHR Noise in the ED

$99,019,337

Strategic Streamlining of Virus Panel Testing in the ED Optimizes Clinical Decision Support

Strengthening Our Technology Value Supply Chain Through Vendor Contract Management

Dual Data Center Improves Business Continuity

Reporting Platform and Database Integration Aligns with EHR and Generates Substantial Cost Efficiency

Storage Infrastructure Consolidation, Migration, and Refresh Optimizes Data Center Performance

Backup Technology Refresh Operates on Renewed Support Model with Optimized Benefits

Audit and Service Realignment Keeps Telephony Communications Operating Effectively

Infrastructure Hardware License Renegotiation Offers More Efficient, Extended Support

Archive Services Head to the Cloud

New Microsoft Enterprise License Agreement Flexes to Meet New Enterprise Needs

24x7 Phishing Detection Becomes More Advanced

Virtualized Infrastructure Enterprise License Agreement Renewal Generates Efficiencies and Savings

Penn Medicine Lancaster General Hospital Gains Infrastructure Platform Storage Refresh

Enterprise-wide Data Center Consolidation Unifies Systems, Optimizes Performance

Cloud Based Faxing Technology Streamlines Data Transmission, Reduces Cost

Penn Medicine’s Primary Care Network Expands through Tandigm Health

Penn Symphony Exam Room Software Makes Effective Use of Clinical Resource Management

Cancer Registry Case Finder (CRCF) Application Creates Efficiencies for Case Finding and Reporting

New Infant Feeding Application Facilitates Efficiencies in the Penn Medicine NICUs

Secure Texting Platform Integrates with EHR Application, Increases Patient Care Efficiency

Iris Careboard and Outside Door Display Modernize Patient Experiencein the HUP Pavilion

Patient Statement Process Redesign Optimizes Hospital and Professional Billing Services

Note: Some projects have both a one time savings and avoidable costs financial benefit.

TRANSFORMATIONAL TECHNOLOGIES LEADING INNOVATIONS IN THE INDUSTRY

healthcare organizations to innovate, adapt, and lead in a complex and dynamic environment. Penn Medicine, a recognized leader in this evolving field, is strategically positioned to not only respond to these changes but also to set new benchmarks for excellence in healthcare delivery. With a robust strategic vision and a commitment to innovative toward new initiatives, Penn Medicine is navigating the future of healthcare with foresight and resilience.

Penn Medicine’s strategy for navigating this landscape is articulated through its comprehensive 5-year strategic plan, which outlines the organization’s path to achieving its mission of delivering exceptional patient care, advancing medical research, and improving community health. The plan is built around five key pillars, each representing a focused commitment to advancing healthcare delivery, fostering innovation, enhancing patient experiences, developing the workforce, and promoting sustainability. Together, these pillars provide a cohesive framework that positions Penn Medicine to thrive amid a rapidly changing healthcare environment. Our Information Services team is consistently evolving and driving change in the industry within the following notable areas of focus and beyond.

Digital Health Transformation

Digital transformation is reshaping healthcare, fundamentally altering how care is delivered, managed, and experienced. The adoption of digital tools, such as telemedicine, electronic health records, and mobile health applications, is no longer a mere convenience—it is a necessity. These technologies have become critical in enhancing patient engagement, improving accessibility, and streamlining operations. The COVID-19 pandemic accelerated the adoption of digital health, demonstrating its potential to maintain continuity of care when traditional in-person visits are not feasible. According to a McKinsey & Company report, telehealth utilization remains 38 times higher than pre-pandemic levels, illustrating the sustained demand for digital healthcare services. This significant shift highlights the growing preference for remote care options, driven by patient expectations for convenience, safety, and accessibility.

Digital health transformation represents a critical evolution in how healthcare is delivered, breaking down geographical barriers, reducing wait times, and enabling more personalized care. Digital health tools empower patients to manage their health proactively, enhance communication between patients and providers, and facilitate more efficient use of healthcare resources. For healthcare organizations, embracing digital health is not just about keeping pace with technological change—it is about redefining the patient experience and ensuring that care is accessible and responsive to patient needs. This transformation enables the organization to innovate and expand upon new ways of providing exceptional care to our patients.

Penn Medicine is at the forefront of this digital shift, focusing on expanding its digital health capabilities to create and enable a more accessible, patient-centered healthcare environment. The organization has made substantial investments in its telehealth platform, allowing patients to receive high-quality care from the comfort of their homes. Additionally, Penn Medicine is enhancing its EHR system to integrate mobile health tools, providing patients with greater access to their health information and promoting more active engagement in their care. These initiatives are part of a broader strategy to leverage technology to enhance patient experience, improve health outcomes, and reduce the overall cost of care, ensuring that Penn Medicine remains a leader in delivering high-quality, accessible healthcare.

Advancing the Future of Medicine through Research

At Penn Medicine, the future of healthcare is being reshaped by cutting-edge research that is pushing the boundaries of medical science. Through initiatives in precision medicine, immune health, and cancer interception, Penn Medicine is not only treating diseases but revolutionizing how we diagnose and prevent them. These pioneering efforts are transforming patient care, offering personalized treatment and hope to individuals facing some of the most challenging health conditions.

Precision Medicine: Personalized Care for Every Patient

Precision medicine is at the heart of Penn Medicine’s innovative approach to healthcare. By tailoring treatments to each patient’s genetic makeup, history, and lifestyle, Penn Medicine is creating care plans that are as unique as the individuals they serve. This approach allows for earlier and more accurate diagnoses, helping patients receive the right care at the right time. Tools like liquid biopsy, a non-invasive blood test, are key to this effort, providing a way to detect tumors quickly and more effectively than traditional methods.

But precision medicine goes beyond finding the latest treatments—it is about discovering what works best for each patient. Penn Medicine’s approach considers that people respond differently to treatments, and in some cases, the best solution may not be the newest drug or therapy, but a more tailored approach. By focusing on the individual, Penn Medicine is crafting personalized care that ensures patients receive treatments designed specifically for them.

Immune Health: Decoding the Body's Defenses

At the forefront of research is Penn Medicine’s work in immune health, a new and rapidly advancing field seeking to unlock the secrets of the immune system. Penn Medicine’s scientists are developing ways to understand the immune system’s complex signals, which play a critical role in fighting disease and maintaining overall health. By profiling a patient’s immune system, they hope to develop personalized treatments for a range of illnesses, from autoimmune diseases to cancer.

This bold vision is being realized through the establishment of Penn’s Institute for Immunology and Immune Health (I3H), a state-of-the-art research center dedicated to cracking the immune system’s code. By understanding how the immune system responds to disease and therapy, researchers aim to create treatments that are more precise and effective, opening the door to new possibilities in how we approach healthcare across a variety of conditions.

Cancer Interception: Stopping Cancer in Its Tracks

In the realm of cancer research, Penn Medicine is taking an innovative approach called cancer interception, which focuses on catching abnormal cells before they develop into cancer. Instead of waiting until cancer progresses, researchers are using advanced tools to identify and stop cancerous cells in their earliest stages. This approach offers a new hope for patients, particularly those at high risk for certain cancers, like those with BRCA gene mutations.

This effort is supported by a range of emerging technologies, such as single-cell sequencing and blood-based biomarker tests, which are helping Penn Medicine’s researchers detect cancers earlier than ever before. By focusing on early detection and interception, Penn Medicine is not only treating cancer more effectively but working to prevent it from taking hold in the first place, potentially transforming how we think about cancer treatment and care.

Together, these research initiatives are driving Penn Medicine toward a future where healthcare is more personalized, more precise, and more preventive. As an academic research medical center, Penn Medicine is leading the way in reimagining what is possible in medical science, improving outcomes for patients, and advancing the future of medicine.

Artificial Intelligence and Advanced Analytics

Artificial intelligence (AI) and advanced analytics are transforming healthcare by enabling more precise diagnoses, personalized treatment plans, and improved operational efficiencies. The ability of AI to analyze vast datasets and uncover patterns that might be missed by human analysis is revolutionizing both clinical and administrative functions within healthcare. AI-driven technologies are increasingly being used to enhance diagnostic accuracy, optimize treatment pathways, and predict patient outcomes, providing a powerful tool for improving patient care. A study published in The Lancet Digital Health found that AI can outperform clinicians in diagnostic accuracy by up to 15% in certain specialties, such as radiology and pathology. This capability is particularly significant in specialties where diagnostic precision is crucial for effective treatment planning.

The integration of AI in healthcare goes beyond diagnostics. AI and machine learning are also playing pivotal roles in predicting patient admissions, managing hospital resources, and optimizing supply chains. The use of predictive analytics allows healthcare organizations to anticipate patient needs, streamline operations, and enhance decision-making processes. This capability is increasingly important in a healthcare environment characterized by rising costs, growing patient populations, and complex care needs. AI’s ability to drive efficiencies and improve clinical outcomes makes it an essential tool for any healthcare organization looking to thrive in the modern landscape.

Penn Medicine is actively harnessing the power of AI and advanced analytics to transform its clinical and operational practices. The organization is developing AI-driven tools that enhance diagnostic capabilities, enabling more accurate and timely patient care. By integrating AI into its clinical workflows, Penn Medicine aims to reduce diagnostic errors, personalize treatment plans, and improve patient outcomes. Additionally, Penn Medicine is leveraging AI to optimize its operational processes, from scheduling and resource allocation to patient flow management. This dual focus on clinical and operational applications of AI reflects Penn Medicine’s commitment to using innovative technology to enhance care delivery and operational performance, aligning with its broader mission of providing exceptional patient care.

Population Health and Preventive Care

As the healthcare industry continues to shift from a fee-for-service model to value-based care, there is an increasing emphasis on population health management and preventive care. This approach focuses on proactively managing the health of patient populations, preventing the onset of chronic diseases, and addressing social determinants of health to improve outcomes and reduce costs. Effective population health management can lead to significant cost savings and better health outcomes by reducing hospital readmissions and avoiding unnecessary medical interventions. The American Hospital Association (AHA) reports that effective population health initiatives can reduce hospital readmissions by up to 15%, significantly impacting patient outcomes and healthcare costs. This trend underscores the importance of shifting from reactive to proactive healthcare models.

The significance of population health lies in its holistic approach to care. By focusing on prevention and early intervention, healthcare organizations can improve patient outcomes, enhance quality of life, and reduce healthcare costs. Addressing social determinants of health—such as access to healthy food, stable housing, and education—also plays a critical role in improving population health outcomes. This approach aligns with the broader goals of healthcare reform, which emphasize value over volume, patient-centered care, and health equity.

Penn Medicine is committed to advancing population health through a variety of innovative initiatives aimed at addressing the root causes of health disparities. The organization is expanding its community health programs to include preventive screenings, chronic disease management, and wellness initiatives. By leveraging data analytics to identify at-risk populations and implementing targeted interventions, Penn Medicine is working to reduce health disparities and improve health outcomes across the communities it serves. These efforts are central to Penn Medicine’s mission to deliver equitable, high-quality care and promote community well-being, demonstrating a proactive approach to healthcare that aligns with the industry’s shift towards value-based care.

Cybersecurity and Data Protection

As healthcare becomes increasingly digital, the importance of cybersecurity and data protection has never been greater. With the widespread adoption of electronic health records, telehealth, and mobile health applications, healthcare organizations are more vulnerable than ever to cyber threats. Protecting patient data is not only a regulatory requirement but also a fundamental aspect of maintaining patient trust and ensuring the integrity of healthcare delivery.

The significance of cybersecurity in healthcare extends beyond financial losses. Data breaches can have severe consequences, including compromised patient safety, disrupted operations, and reputational damage. In an environment where trust is paramount, ensuring the security and confidentiality of patient information is essential for building and maintaining strong patient relationships. Furthermore, robust cybersecurity practices are critical for supporting innovation in digital health, as they provide the secure environment needed for digital tools and platforms to thrive.

Recognizing the importance of cybersecurity, Penn Medicine is making significant investments in advanced cybersecurity technologies and practices to protect patient data and ensure continuity of care. The organization is implementing state-of-the-art security measures, including encryption, multi-factor authentication, and continuous monitoring, to safeguard against potential threats. Additionally, Penn Medicine is fostering a culture of security awareness among its staff through regular training and education programs. By prioritizing data protection, Penn Medicine is not only complying with regulatory standards but also reinforcing its commitment to patient safety and trust, enabling it to continue leveraging digital innovation in a secure and responsible manner.

Operational Efficiency and Cost Management

In today’s healthcare environment, operational efficiency and cost management are critical for maintaining financial sustainability and delivering high-quality care. Rising healthcare costs and shrinking margins are pressing challenges that require healthcare organizations to optimize their operations, reduce waste, and improve resource utilization. According to Deloitte’s 2023 Healthcare Outlook, achieving operational efficiencies is essential for health systems to remain financially viable and competitive. Streamlining processes, adopting new technologies, and fostering a culture of continuous improvement are key strategies for achieving these objectives.

The importance of operational efficiency lies in its ability to enhance care delivery while managing costs. By reducing administrative burdens, improving workflow management, and optimizing supply chains, healthcare organizations can improve patient outcomes and reduce the cost of care. Efficient operations also allow organizations to allocate resources more effectively, ensuring that they are wellequipped to meet patient needs and respond to changing healthcare demands.

Penn Medicine is dedicated to enhancing operational efficiency through a comprehensive approach that includes streamlining clinical workflows, reducing administrative burdens, and optimizing supply chain management. The organization is adopting lean management principles and data-driven decisionmaking tools to identify and eliminate inefficiencies, improve resource utilization, and enhance service delivery.

These efforts are designed to support Penn Medicine’s broader goals of providing high-quality, cost-effective care and ensuring long-term financial sustainability in a competitive healthcare landscape.

Patient-Centric Care Models

Patient-centric care models are transforming healthcare by emphasizing personalized, compassionate care that is tailored to individual patient needs. This approach focuses on enhancing patient experiences, improving communication, and building stronger patientprovider relationships. Research from the Institute for Healthcare Improvement (IHI) shows that patient-centered care models can improve patient satisfaction scores by 20% and reduce hospital stays by 10%. The growing emphasis on patient-centric care reflects a broader industry trend towards delivering care that is not only clinically effective but also responsive to the preferences and experiences of patients. By focusing on the needs and preferences of patients, healthcare organizations can create more meaningful interactions, enhance trust, and foster better engagement. This approach also supports better care coordination, reduced medical errors, and more efficient use of healthcare resources, contributing to improved overall quality of care.

Penn Medicine is committed to advancing patient-centric care through a variety of initiatives aimed at enhancing patient experiences and improving care delivery. The organization is redesigning its care processes to make them more patient-friendly, including implementing digital tools that facilitate better communication and engagement. By focusing on improving the patient experience, Penn Medicine is building stronger relationships with its patients and communities, enhancing satisfaction, and ensuring that care delivery is both effective and compassionate.

Workforce Development and Retention

Workforce development and retention are critical priorities in a rapidly changing healthcare environment. The healthcare industry faces a significant challenge in attracting and retaining skilled professionals, particularly in the face of an aging workforce and increasing demand for healthcare services. The Association of American Medical Colleges (AAMC) predicts a shortage of up to 124,000 physicians by 2034, highlighting the need for innovative workforce strategies. Instituting measures to sustain physician wellness through EHR optimization and make care provision easier on clinical staff through tools like AI are of utmost importance. Ensuring a well-trained, IS motivated workforce is also essential for delivering high-quality care and achieving organizational goals. The importance of workforce development lies in its ability to ensure that healthcare organizations have the talent and expertise needed to meet patient needs and adapt to evolving industry demands. Investing in training, professional development, and retention strategies not only helps attract top talent but also fosters a culture of continuous improvement and innovation, which is crucial for maintaining high standards of care and driving organizational success.

Penn Medicine is proactively addressing workforce challenges by investing in comprehensive workforce development programs that attract, retain, and develop top talent. The organization is focused on creating a supportive environment that encourages continuous learning and professional growth, offering robust training programs, mentorship opportunities, and flexible career pathways. Penn Medicine is on a journey to become a high reliability organization (HRO). HROs are dedicated to using proven processes to make sure things go smoothly, even in complex situations. They are relentless in stopping medication errors, mix-ups in patient information, infections, falls, and injuries before they happen. And, when something unexpected does occur, HROs address issues quickly and learn from them to make things even better. Being an HRO means fewer mistakes, better outcomes for patients, and an overall safer place to be cared for and to work.

By fostering a culture of excellence and innovation, Penn Medicine ensures that its workforce is well-equipped to meet future healthcare challenges and continue delivering exceptional care.

Environmental Sustainability

The healthcare sector is responsible for nearly 4.5% of global greenhouse gas emissions, making sustainability efforts essential for the future of the industry (Healthcare Without Harm, 2024). Sustainability is increasingly becoming a focus in healthcare as organizations recognize their role in promoting environmental health and reducing their ecological footprint. The significance of sustainability in healthcare lies in its potential to improve both environmental and public health. By reducing waste, conserving resources, and minimizing emissions, healthcare organizations can contribute to a healthier environment and mitigate the impacts of climate change on public health. Additionally, sustainability efforts can lead to cost savings and operational efficiencies, supporting the financial health of healthcare organizations.

Penn Medicine is committed to advancing environmental sustainability through a variety of initiatives aimed at reducing its ecological footprint and promoting environmental health. The organization is implementing energy-efficient building practices, reducing waste, and promoting the use of renewable energy sources. By integrating sustainability into its operations, Penn Medicine not only contributes to a healthier environment but also demonstrates its leadership in sustainable healthcare practices, setting an example for other health systems to follow.

Penn Medicine’s strategic vision and innovative initiatives position the organization as a leader in the ever-evolving healthcare landscape. By aligning with industry trends such as digital transformation, AI integration, population health management, cybersecurity, operational efficiency, patient-centric care, workforce development, and sustainability, Penn Medicine is well-equipped to meet the challenges and opportunities of the future. The organization’s commitment to excellence, innovation, and community well-being ensures that it remains at the forefront of healthcare innovation and delivery.

As Penn Medicine looks to the future, it does so with a renewed sense of purpose and a clear strategic direction. The initiatives and projects highlighted in this story are more than just responses to industry trends; they are forward-thinking actions designed to shape the future of healthcare. By staying true to its core values of compassion, excellence, and sustainability, Penn Medicine is poised to lead the way, ensuring it continues to make a meaningful impact on the communities it serves. With a steadfast commitment to innovation, patient care, and sustainability, Penn Medicine is set to remain a beacon of excellence in an ever-changing world.

BENEFITS CATEGORY EMPOWERING TECHNOLOGIES

2022 $3,428,332

2023 $11,863,887

2024 $10,648,379

2025 $10,386,620

2026 $10,386,620

2027

$7,824,529

TOTAL $54,538,366

Projects are reported for fiscal years 2022 and 2023.

Projected financial benefits from projects completed in prior years are displayed in the thirteen-year summary on page 75.

Strengthening Our Technology Value Supply Chain Through Vendor Contract Management

BACKGROUND DESCRIPTION

Information Services manages over 1,100 software or technology related contracts for the Penn Medicine organization. The IS contracts consist of the following categories: New IS service or technology agreements, contract renewals, amendments, supplements, and schedules, consulting agreements and third-party value-added resellers. As such, contract review and negotiations play a pivotal role in managing our service agreements and vendor relationships. IS contract management resources continually search for contract efficiencies, service optimization, and identify contract cost saving opportunities that may exist or become available throughout the enterprise. Although inflationary pressures occurring over the last two fiscal years have kept pricing in line with current inflationary conditions, the IS Contract Management team nonetheless continues to identify and secure contract benefits for the organization.

The cumulative impact of contract management efforts demonstrates the long-term benefits of effective contract management and negotiation practices by the IS team. The significant cost savings realized through ongoing contract negotiations efforts underscore the contribution of our organization's procurement and contract management efforts. Through the strategic application of negotiation methods, the team has demonstrated a commitment to fiscal responsibility and maximizing value for stakeholders.

BENEFITS REALIZED

Through strategic methods such as restructuring, negotiating term extensions, examining utilization ratios for optimization, and assessing product usefulness, IS Contracts was able to save more than $5.2 million in FY22/23, and realize a total of over $21.8 million over the next five years. These savings/cost avoidance measures directly contribute to the financial stability of the organization.

$25,000,000

$20,000,000

$15,000,000

$10,000,000

$5,000,000

$21,834,212

Dual Data Center Improves Business Continuity

BACKGROUND DESCRIPTION

Penn Medicine sought to provide a High Availability (HA) technology environment for redundant computing capacity and mirrored storage to co-exist across two geographically diverse data centers. The two data centers could share load between them or transition load quickly from one to the other, allowing our EHR to run in either data center at any time, easily moving between them. This result dramatically improved the business’ ability to maintain normal operations even if an entire data center was lost to a disaster.

During this year long project, the infrastructure team wrote hardware specifications and placed orders with our hardware vendors. Preparatory work at both data centers was completed in spring 2023, in time to support hardware delivery by July 2023. Once the hardware was installed and commissioned, the EHR application team was engaged in August 2023 to perform testing and go-live planning. The launch was successfully orchestrated in November 2023, when the EHR environment was transitioned for the first time from the Newark location to the Philadelphia data center.

BENEFITS REALIZED

Common compute and storage platforms were installed across the Newark, Delaware, and Philadelphia datacenters, enabling the following outcomes:

• $15 million in operating reduction; projected over 5 years, from reduced maintenance costs, elimination of the EHR disaster recovery contract costs, and operational efficiencies gained because of common platforms across the data centers.

• Mirrored infrastructure, achieving fully redundant core network services.

• New technology framework, capable of supporting defined business recovery point (RPO) and recovery time (RTO) objectives.

• Supported real-time data replication to satisfy our application team requirements.

• Enhanced operating model, planning, and governance.

• Implemented new security application, securing the EHR and core network services against ransomware attacks.

• Deployed the EHR as the initial business application to take advantage of this environment; other applications will be added in future years.

$16,000,000

$14,000,000

$12,000,000

$10,500,000

$8,000,000

$6,000,000

$4,000,000

$2,000,000

$6,000,000 $3,000,000 $6,000,000

$15,000,000

Reporting Platform and Database Integration Aligns with EHR and Generates

Substantial Cost Efficiency

BACKGROUND DESCRIPTION

In 2021, Penn Medicine began a multi-year project to transition to a new reporting platform also supported by new databases. The primary driver of this initiative was to integrate reporting functionality within our electronic health record system.

The project also provided an opportunity for Penn Medicine to reduce the total number of reports to support and maintain. At the beginning of the project there were 17,630 reports being supported and maintained on our servers, with 68% being retired after transition. Also, total report subscriptions were reduced by over 2,000. This reduction in total reports and subscriptions not only meant less reports that needed to be continuously supported and maintained by IS resources, but it also meant better technology performance due to less unnecessary volume on Penn Medicine servers.

Penn Medicine leveraged the relationships and tools of its strategic technology partners, as the reporting platform transition impacted every area of the health system from the clinical setting to operations and the finance department. By removing third party report and database systems, Penn Medicine saved on annual support costs and reduced the potential risks that came with maintaining a platform through an external environment.

BENEFITS REALIZED

• Cost savings of $860,000 in annual third-party support and licensing costs, resulting in $4.3 million over 5 years. The cost avoidance for this project is the reduction in the total number of reporting platforms in use at Penn Medicine, and the reduction in total reports and subscriptions that need to be supported and maintained ongoing.

• Reduction in total number of reports to support and maintain.

• Reduction in total number of reporting platforms and databases to support and maintain.

• Promotion of reporting self-sufficiency by the migration to the new reporting platforms.

$4,500,000

$4,000,000

$3,500,000

$3,000,000

$2,500,000

$2,000,000

$1,500,000

$1,000,000

$500,000

Storage Infrastructure Consolidation,

Migration, and Refresh

Optimizes Data Center Performance

BACKGROUND DESCRIPTION

Penn Medicine leverages vendor-hosted services and support for a variety of storage technology located in two, geographically dispersed data centers. Reliability and supportability are driven by the useful life of equipment and manufacturer’s support. Furthermore, maintaining supported equipment is critical to ensure availability of parts, software support, and availability of cyber vulnerability patches. However, a number of these storage platforms were nearing their end of useful life, soon to be unsupported by the manufacturer.

Penn Medicine Information Services partnered with the hosting vendor to define a future state architecture leveraging an enhanced and highly resilient storage environment to address the near obsolescence at both datacenters. The replacement equipment resulted in a robust consolidation of mixed workloads by having moved from six storage arrays to two.

In one data center, a newer, more robust storage platform was acquired to replace the existing aging storage system. In the second data center, an even more robust storage platform was purchased to consolidate five smaller, aging storage systems. With the consolidated refresh at both centers, the overhead capacity for growth improved from 20% to 40%.

BENEFITS REALIZED

• The technology refresh and combination of older storage platforms into newer storage systems, along with receiving trade in value for one for the older storage platforms, resulted in a combined reduction of $67,908 monthly, a total of $4,074,480 over 5 years.

• A new agreement to pursue a project for the full parallel migration services to consolidate the data from the old storage platforms to the two new storage systems was also negotiated.

Considering the storage, software, and support savings amid the data migration costs, the net savings are $4,074,480 over 5 years, or $814,896 annually.

$4,500,000

$4,000,000

$3,500,000

$3,000,000

$2,500,000

$2,000,000

$1,500,000

$1,000,000 $500,000 $0

$4,074,480 $1,629,792 $814,896 $1,629,792

Backup Technology Refresh Operates on Renewed Support Model with Optimized Benefits

BACKGROUND DESCRIPTION

Penn Medicine’s vendor hosted data center backup technology was aging and nearing end of life in November 2022. The data backup protection solution provided data resiliency for our applications and associated data, as well as user and departmental shares used for data and system restoration for disaster recovery scenarios or cyber-attacks. Prior to the contract ending, we evaluated competitive options for future service with other suppliers and even considered insourcing this service to our infrastructure team. After weighing the associated risks regarding additional staff support, operational processes required for insourcing the service, and hardware support of the backup ecosystem, we determined that the data protection program was best to remain outsourced with the data center vendor.

The result of our due diligence and negotiation efforts for the upcoming service contract yielded refreshed technology, and better alignment with the data center vendor’s proposal to coincide with our projected FY23 budget, while providing cost-avoidance over the 4 years of the new negotiated deal.

BENEFITS REALIZED

The result of the technology refresh and associated contract renegotiation produced the following:

• Savings achieved in fiscal year 2023 were $300,000.

• Additional cost avoidance resulting in $1,600,000 over a 4-year period, ($400,000 annually).

$2,000,000

$1,500,000

$1,000,000

BACKGROUND DESCRIPTION

Penn Medicine provides a wide variety of telephony services to the organization. Overall, these services have multiple vendor service provider contracts resulting in over three hundred monthly invoices. The telecommunications team took the opportunity to conduct a telephony audit in order to optimize costs, improve billing accuracy, enhance vendor relationships, ensure compliance, and mitigate risks associated with telecommunication expenses for Penn Medicine. The insights gained from the telephony audit helped inform strategic decisions about telecommunications investments, technology upgrades, and future service requirements.

The audit included a review of telephony service provider contracts, all related invoices, and operational workflows. While telephony invoices can be complex, errors are not uncommon. The audit helped further ensure that billing was accurate and in line with agreedupon rates and contract terms. The audit also provided valuable information related to managing relationships with telecommunication vendors, including negotiating better rates, resolving billing disputes, and fostering optimal service quality by managing vendor accountability. Conducting regular telephony invoice audits in the future will also help uncover inefficiencies in telecommunication procurement, usage, and billing processes, leading to process improvements and continued expense reductions.

BENEFITS REALIZED

• Cost Savings: As a result of the audit, Penn Medicine identified over $1,550,534 in cost savings and expense reduction through renegotiated contracts, service optimization, and reduced billing errors.

• Budget Control: The telephony invoice audit provided insights into telecommunication expenses, allowing departments to better forecast and control their telecommunications budgets.

• Compliance: Ensuring accurate billing and compliance with contractual agreements helped the organization maintain compliance with internal policies and external regulations.

• Process Improvement: Conducting regular telephony invoice audits helps uncover inefficiencies in telecommunication procurement, usage, and billing processes, leading to process improvements and cost reductions over time.

• Optimization of Services: By reviewing telephony usage patterns and costs, we can continue to identify opportunities to optimize telecommunications services, such as renegotiating contracts, adjusting service plans, or consolidating providers.

$1,600,000

$1,400,000

$1,200,000

$1000,000

$800,000

$600,000

$400,000

$1,550,534

$200,000 $0 $1,550,534

Infrastructure Hardware License Renegotiation Offers More Efficient, Extended Support

BACKGROUND DESCRIPTION

The license agreement for our infrastructure hardware is a highly customized software contract that offers unprecedented flexibility in the way software titles are consumed and maintained for our enterprise compute, data storage, and backup hardware platforms. With one service cycle remaining on the current contract, a new extended agreement was negotiated for a 5-year term. Value and savings were achieved through economies of scale, predictable total cost of ownership, and price protection. Penn Medicine worked to restructure the existing agreement into a longer term to continue optimizing technology at premium cost savings.

BENEFITS REALIZED

The contract negotiation resulted in the following savings and reductions:

• Overall reduction in operating expense of $1,453,365 over 5 years, or $290,673 annually.

$1,600,000

$1,400,000

$1,200,000

$1000,000

$800,000

$600,000

$400,000

$200,000

Archive Services Head to the Cloud

BACKGROUND DESCRIPTION

The Infrastructure Engineering and Operations group supports research computing services for Linux-based cluster computing systems, High Performance Computing (HPC), database and web servers at the Perelman School of Medicine at the University of Pennsylvania. The HPC environment has operated an on-premise, tape-based archive system - housing 1,100 Terabytes of data as of January 2023. At that time, the hardware and software that provided the service were reaching end-of-support. Therefore, our team took the opportunity to assess and determine the most ideal platform to host these services in the future.

Upon deciding that the cloud was the best environment to host and support our researcher’s data, the technology team began the migration from January through May of 2023. User data was retrieved from tape, documented, and then uploaded to the cloud with file counts and data volumes carefully compared to the originals. Security measures included data access being restricted to only the HPC file transfer host, and the use of FIPS 140-2 compliant 256-bit AES encryption for cloud data.

BENEFITS REALIZED

• Estimated cost savings for researchers over 5 years: $924,000.

• 93% reduction in archive storage costs to researchers, from $15/TB/month to $1/TB/month, which on 1,100 TB is a cost savings of $184,800 per year.

• Estimated cost avoidance over 5 years: $345,035.

• Eliminated $61,920 annual hardware and software costs for on-premise infrastructure.

• Avoided operating expenditures for tape storage media averaging $7,087 per year.

• Avoided capital expenditure for new hardware.

$1,400,000

$1,200,000

$1000,000

$800,000

$600,000

$400,000

$200,000

New Microsoft Enterprise License Agreement Flexes to Meet New Enterprise Needs

BACKGROUND DESCRIPTION

The healthcare IT industry has been predominantly PC based since computers began emerging. Generally speaking, a Microsoft Enterprise License Agreement (ELA) has provided organizations with volume discounts, cost savings, flexibility, simplified management, and access to the latest software updates and support services, making it a valuable investment for many businesses. For Penn Medicine, a challenge emerged in seeking ways to provide for the growing needs of the organization while managing increasing costs in order to achieve maximum value of a new service agreement.

Penn Medicine made several adjustments in pursuit of a new agreement to gain additional benefits and cost savings. We upgraded to the latest version 5 Enterprise Licensing Agreement model and bundled our licensing to attain increased volume licensing discounts. A unique advantage of switching to this licensing structure was that a broad array of cyber security products were now available to Penn Medicine. This new toolset positioned Penn Medicine to increase the organization’s threat detection monitoring, data loss prevention, and endpoint security. Access to this new library of cyber defense products helped our team build a new plan featuring new products to protect against sensitive data from unauthorized access, theft, and manipulation.

The new agreement introduced a flex-down option for some of our core licenses, allowing Penn Medicine to have the ability to reduce certain license costs within the term of the agreement. By taking advantage of the newest version of Microsoft licensing, with its newly added all-inclusive features, Penn Medicine also gained the opportunity to eliminate and consolidate existing third-party applications and their associated cost.

BENEFITS REALIZED

• Cost Savings: Over the course of 5 years, the renegotiated agreement resulted in total savings of $1,243,605.

• Flexibility: The ELA allowed our organization to deploy a wide range of Microsoft products and services across the infrastructure, offering flexibility in software usage.

• Predictable Budgeting: With an ELA, software costs can be predicted over a multi-year period, helping with budget planning and forecasting.

• Simplified Management: The ELA streamlined license management and compliance, making it easier to track and manage software assets.

$1,400,000

$1,200,000

24x7 Phishing Detection Becomes More Advanced

BACKGROUND DESCRIPTION

Email communication is essential to any business and is leveraged by all employees. Keeping this tool safe is essential as attackers use email-based scams (malicious email or phishing) to initiate ransomware attacks. A report by Sophos, The State of Ransomware in Healthcare 2023, found that these types of attacks are the root cause of 36% of all ransomware attacks on healthcare. Given the increase in email attack sophistication, the cybersecurity team partnered with a phishing detection and response service that rapidly receives, assesses, and remediates phishing attacks against Penn Medicine to better protect the organization and provide timely response activities.

Our security operations team historically received a high volume of reported phishing emails every day. Each validation process took upwards of an hour to assess the extent of the malicious impact. To add more pressure to the situation, the repetitive nature of phishing review impacted morale and staff retention, especially when there was a significant influx of phishing emails that could not be reviewed and responded to in a timely manner. By outsourcing the phishing monitoring and analysis to a dedicated team of experts, phishing reports were triaged in the context of the organization, and all customers. When a valid phishing email was reported and confirmed malicious, the service empowered our messaging system to automatically remove the email from all instances/mailboxes that received it.

Our risk and compliance team maintained an essential employee phishing awareness program to combat email-based attacks by sending simulated malicious email messages to all users each month. Prior to implementation of the new service, this was a manual and inefficient process. A staff member crafted a proposed malicious email and manually managed the user list monthly. The messages were sent to all users and while basic “pass” and “failure” counts were provided, more insightful metrics were not available. The service from our new partner, however, offered various online training modules, permitting targeted training opportunities for employees to enhance overall awareness. This compounding effect quickly brought value back to Penn Medicine and unified real-time detection, proactive response, user education, and time savings for the team.

BENEFITS REALIZED

• Using the external service saves Penn Medicine about $160,000 per year, relative to equivalently trained FTEs. If we replicated this service with staff, it would take at least 4 analysts working in rotation, including benefits and off-hour pay.

• Following the implementation, the true rate of phishing detection increased by more than 7%, with more than 4.8 times more emails reported for phishing analysis.

• The average time to detection and response with the internal team was 4 hours. With the new solution, it dropped to approximately 17 minutes, a 1300% improvement!

• The team could now focus on true phishing attempts, armed with additional insights and the ability to trend over time.

• All corporate users, representing over 60,000 email accounts, could report suspicious emails and within less than 30 minutes receive a response with the analysis and next steps.

• During this time, the cybersecurity monitoring team receives necessary information so that appropriate actions can be taken swiftly to protect the organization against emerging email campaign threats.

BENEFITS REALIZED

• The new service offers a much more robust simulation platform. “Real” attack messages are readily transformed into awareness campaigns through a library provided by this service.

• A directory synchronization capability simplifies the user management process.

• The system includes a mailbox tracking capability, so it only sends the simulation to a given user while their mailbox is active, thereby increasing the likelihood that more employees will see the simulation and need to determine whether the message is suspicious or safe.

• Historical user records are maintained, allowing monthly performance monitoring.

• We can more readily track progress over time and generate more significant metrics in support of our key risk indicators.

With far more sophisticated user awareness and malicious email detection capabilities, the new phishing response and user awareness system has transformed our email defense capabilities.

$800,000

$700,000

$600,000

$500,000

$400,000

$300,000

$200,000

$100,000

Virtual Infrastructure Enterprise License Agreement Renewal Generates Efficiencies and Savings

BACKGROUND DESCRIPTION

Our enterprise license agreement is a highly customized software contract that offers unprecedented flexibility in the way that software licenses are consumed and maintained. Around the time of the approaching contract renewal, Penn Medicine finalized a new virtualization strategy. The new plan reflected the strategic direction for additional growth, value, and savings achieved through economies of scale, and the predictable total cost of ownership (TCO). As a result, Penn Medicine worked to negotiate a new 3-year contract, creating more efficient alignment with the services and support of the new strategy. The new agreement also enabled secure price protection for additional licensing of our enterprise virtual environments.

BENEFITS REALIZED

In addition to covering Penn Medicine’s existing license entitlements along with entitlements for upcoming strategic initiatives, the team was able to negotiate an additional contract rebate and funding for professional services.

• A $50,000 services credit was applied for vendor virtual services.

• A contract rebate of $494,000 was refunded to Penn Medicine to be accrued over 36 months, aligning with the contract payment.

• FY24 savings: $164,666

• FY25 savings: $164,667

• FY26 savings: $164,667

Penn Medicine Lancaster General Hospital Gains Infrastructure Platform Storage

Refresh

BACKGROUND DESCRIPTION

Penn Medicine Lancaster General Hospital’s EHR storage infrastructure was reaching end-of-life, requiring an upgrade to a newer class of storage following a thorough review of current and potential replacement hardware. Adoption of this new storage system aligned Penn Medicine Lancaster General Hospital with the same storage technology used in the dual datacenter project and Penn Medicine’s EHR environment, ensuring consistency and compatibility across the Health System. This upgrade elevated the organization's most critical digital asset to a tier 1 industry platform, while also leveraging scalability. The enhanced capabilities included advanced services such as encryption and data reduction, which enabled the infrastructure team to effectively continue to safeguard sensitive patient information. This transition also enhanced the user experience, contributing to improved patient care outcomes.

BENEFITS REALIZED

The transition represents a key strategic move forward for Penn Medicine Lancaster General Hospital, driven by several key factors. The new storage class unlocked superior scalability and performance capabilities, empowering the hospital to efficiently manage expanding data volumes. With enhanced input/output processing and bandwidth, we now have rapid data access, critical for handling the complexities of healthcare datasets. Moreover, advanced data services provide inline data reduction and encryption, bolstering security and efficiency. Integration of machine learning and predictive analytics enables proactive issue detection, minimizing downtime and enhancing system reliability. This comprehensive feature set aligns seamlessly with the organization's evolving needs and vision.

Additionally, the seamless migration process minimizes disruptions, facilitating a smooth transition. Consolidating workloads onto a single, high-performance platform simplifies management and reduces total cost of ownership. This upgrade underscores Penn Medicine’s commitment to investing in innovative storage technology, positioning the hospital for long-term success.

Key benefits of the new EHR infrastructure platform at LGH includes:

• Reduced maintenance of $55,275 in annual cost avoidance, $276,375 over 5 years.

• Innovative storage technology.

• Reduced system downtime through inline patching, in most cases.

• 20 minutes per update, approximately 2-3 or 60 minutes per year.

• Decreased data refresh times from production to test environments.

• Guaranteed 5:1 data reduction using compression.

• High power usage capabilities and all non-volatile memory architecture.

• Designed for Zero Trust security environments, ensuring the world's most secure mission-critical storage.

BACKGROUND DESCRIPTION

As Penn Medicine’s healthcare system has grown through multiple acquisitions over the past several years, multiple dispersed and independent data centers were inherited. These data centers were used to house data and application-based servers, significant file storage, and disaster recovery environments. Each time a newly acquired facility joined our network, it brought a disparate set of technology, which resulted in multiple inefficiencies for our Health System. Aspects of these inefficiencies included duplicate facility costs, low density and half-filled data centers, as well as duplicate staff, system monitoring costs, and additional hardware to maintain.

Key technology leaders and staff assessed the footprint of the data center environment that existed after these mergers occurred. The team then drafted a more improved, logical footprint design for future implementation. Considering today’s use of virtualization for most systems, paired with the continued desire to use high density network and server environments, a plan was set into action to physically move high density data center systems into the least cost data center environments. In addition, the team pursued the retirement of aging systems, as well as making system updates and conversions to high density racks. As a result, in 2022, data centers evaluated as non-sustaining or too expensive to maintain were retired. Those centers that were deemed to be viable for the Health System's future needs were improved by adding power, improving wide area network connections, and adding staff monitoring to ensure that the overall environment was improved by the project. Our Brownstown data center, located as part of Penn Medicine LGH, played a critical part in adjusting and improving our data center efficiencies.

BENEFITS REALIZED

Results for the consolidations performed included:

• Achieving lower building operation costs.

• Improvement of overall system unit maintenance.

• Individual data center support.

• Data centers located in entity and clinically based areas were transitioned to patient focused space.

• After relocating fiber wire back to the hospital at a cost of $42,000, Penn Medicine Information Services was able to save $60,000 in annual rental costs. The total savings over 5 years will equate to $258,000 in reduced rental space.

Cloud Based Faxing Technology Streamlines Data Transmission, Reduces Cost

BACKGROUND DESCRIPTION

Faxing service is a vital part of business operations at Penn Medicine. It remains a critical component of data transmission for regulatory compliance and patient care. In fact, over 28 million faxes are sent and received at Penn Medicine each year. These faxes include clinical orders and results, patient care plans and patient outcomes to and from physicians, clinics, and patients.

To ensure that the increasing demand for faxing is met, Penn Medicine set out to modernize its approach toward this technology. Legacy faxing solutions are costly and lack the redundancy needed to support the organization. The new cloud faxing solution set out to reduce costs, improve redundancy, enhance security, streamline workflows, and support environmental sustainability, while ensuring compliance and business continuity.

BENEFITS REALIZED

In 2023, Penn Medicine introduced cloud-based faxing that quickly produced streamlined workflows and expense reduction. The project included migrating over five hundred fax lines to the cloud. Cloud faxing eliminated the need for some traditional fax machines and phone lines, thereby reducing hardware, maintenance, and operational costs. Users could now receive and send faxes from their desktop PCs. The cloud-based per fax cost resulted in 38% less spending than a traditional fax sent over a phone line.

Penn Medicine became well positioned to easily scale up or down to accommodate changing business demands without the need for additional hardware or infrastructure investments. Modernizing the approach allowed users to send and receive faxes from anywhere with an internet connection, enabling greater flexibility and mobility for remote workers or employees who are on the go.

• Cost Savings: During the first three months of using cloud-based faxing, Penn Medicine achieved a total savings of $34,760:

• November ‘23 = $10,710

• December ‘23 = $11,470

• January ‘24 = $12,580

• Enhanced Security: Advanced security features, such as encryption, secure transmission protocols, and access controls protect sensitive fax documents from unauthorized access or interception.

• Increased Efficiency: By sending faxes over the internet and not older telephones lines, fax times have been reduced.

• Integration: Integrated with existing business applications, document management systems, and email platforms, enabling seamless integration and streamlined workflows.

• Compliance: Helps meet industry regulations, such as HIPAA, GDPR, or PCI DSS, by ensuring the secure transmission and storage of sensitive fax documents.

Increased Threat Protection Gained for Penn

BACKGROUND DESCRIPTION

Penn Medicine websites and web applications are essential to the organization’s communication strategy and provide enhanced customer service for patients, researchers, and partners. To safeguard Penn Medicine's digital presence, brand, and operations, the cybersecurity team enabled web application firewall (WAF) technology to identify and filter malicious traffic and place the websites behind a layer of advanced defense against cyberattacks. Also, this technology allowed the ability to integrate CAPTCHA challenges to validate human activity.

With careful orchestration of numerous teams and extensive testing, the implementation of this technology helps to combat the countless attempts made to disrupt online services. One such disruption that has been on the rise is called Distributed Denial of Service (DDoS), where an attacker floods a server with internet traffic to prevent users from accessing connected online services and sites. According to DDoS-Guard's Analytical Report on DDoS Attacks, "the number of attacks on websites of pharmacies, medical centers, laboratories, and other organizations working in the health sector has also more than tripled. DDoS attacks on these types of resources are often a cover for attempts to obtain confidential patient data and other sensitive information." Similarly, Radware, a global leader of cyber security and application delivery solutions, reports that “downtime due to a successful DDoS attack costs organizations an average of $6,130 per minute, or $367,800 per hour.

Every quarter we block an average of 850,000 individual attack attempts across our 145 websites with the intent to spread malware or steal sensitive data. These attack types range from remote code execution/remote file inclusion-targeting web servers where malicious code is run in attempt to manipulate an application into downloading or executing a file from a remote location. Their goal is to gain access to files by manipulating file paths using malicious code to manipulate databases and gain access to data. The solution provides necessary information to the cybersecurity teams for attack type identification and origin leading to enhanced monitoring and defensibility.

BENEFITS REALIZED

Without this security solution in place, Penn Medicine websites would be at greater risk of hacking attempts, data breaches, and other cyber security threats that could impact our patients and employee’s security and privacy. For example:

• A WAF prevents a denial-of-service attack, which could stop patients from having access to the patient portal if a malicious actor targeted it. This type of activity occurs across healthcare environments because of political and social ‘hacktivism’ to protest a healthcare organization’s association to research and service offerings.

• A WAF analyzes the incoming requests into a website looking for suspicious activity that could indicate that a malicious actor is probing for vulnerabilities on the website that could lead to a website compromise and infection of a website. A common attack strategy by malicious actors is to turn a reputable website into a launching platform for infecting visitors with malicious code.

• A WAF analyzes web traffic for attacks against web server infrastructure that if exploited, would provide an attacker a direct path into a business network. A common attack strategy is to leverage this kind of access to relay into sensitive areas and could lead to loss of patient data, ransomware attacks, and more. SAVINGS QUALITATIVE

New Security Protections are Employed for Laptops and Off-site Computers

BACKGROUND DESCRIPTION

An increasingly remote Penn Medicine workforce (over 54% annually) means increasing network traffic. Cyber criminals know that targeting corporate laptops while connected to home networks and outside the corporate network results in a greater chance of successful attacks. To address this emerging risk, the cybersecurity team implemented a cloud based, secure web gateway that safeguards web browsing on Penn Medicine managed laptops, regardless of location – home, public Wi-Fi, or while traveling. This new web monitoring solution protects over 11,500 active Penn Medicine devices and establishes a process to ensure that inactive devices are secured as they re-connect to Penn Medicine networks.

BENEFITS REALIZED

This new web filtering solution provides protection against cyber criminals trying to deliver web attacks, including sophisticated threats that are not detected by anti-virus solutions and provides an additional layer of protection against targeted phishing attempts. Annually, the web filtering solution blocks over 100,000 automated attacks and safeguards users from clicking on malicious content.

• Laptops and off-site computers are at risk of being impacted by a malicious attack because they are outside the corporate network, and the security controls it provides. In a typical day, there are hundreds, if not thousands of prevented infections that would not have been prevented without this solution in place that extends security controls to the laptop, whether it is at home, or at a coffee shop.

• Attackers can emulate well known, popular public wireless network environments and entrap unsuspecting users into providing sensitive data, like credentials, when prompted by a fake popup or login screen. Deploying this web filtering technology prevents this kind of attack scenario by tunneling web traffic through a secure path that an attacker can access or emulate.

Cybersecurity Keeps an Eye on New Threats with Continuous Analysis

BACKGROUND DESCRIPTION

The technology landscape is constantly changing. Over the last year, this is best illustrated by the explosive growth of Artificial Intelligence (AI) and Natural Language Processing websites and solutions. While there is no doubt that the tools being created have incredible capabilities and can be extremely helpful to healthcare processes, there are also many unknown risks and side effects created as a result of using these untested tools.

For example, AI and Large Language Model (LLM) tools are not perfect and can create ‘hallucinations’ of inaccurate content, which in turn could negatively impact patients. There are also numerous privacy concerns related to the data that is used to train AI and LLM tools, which could cause protected health information (PHI) leakage into results in unexpected and compromising ways. In addition, there are numerous cybersecurity risks that can lead to exposure of passwords, source code, and other security related content if users are not careful about how they interact with these systems. The cybersecurity team looks at new technologies like this and assesses the ‘what ifs’ that need to be considered before broad implementation. As new technologies and discoveries are found, the cybersecurity team develops strategies to manage how our employees can leverage the power of these new tools.

BENEFITS REALIZED

• Safeguards are in place to increase awareness around the risks of usage and guide our colleagues in proper interaction with these tools.

• Controls are introduced, when needed, to prevent unintentional usage of the tools that could lead to unexpected consequences.

Research Storage and Compute Services are Maximized for Penn Medicine Researchers

BACKGROUND DESCRIPTION

The IS Infrastructure Engineering and Operations group has provided research computing services and support to Penn Medicine researchers at the Perelman School of Medicine at the University of Pennsylvania. For many years, the Limited Performance Computing (LPC) cluster relied on a legacy storage system which had restrictions on the maximum size of contiguous space that could be provided to a single project storage directory. Although the 10 Terabyte limit was enough for some researchers, those with larger labs and greater data needs found the limitations to be frustrating and inefficient. Avoiding the limit would require restricting access to the data needing to be moved, moving it, and verifying the accuracy of the move before restoring access. Sometimes logical collections of data would be arbitrarily divided into 2 or more separate areas to accommodate the overall storage requirement.

To remedy the problem, our technology team purchased and installed new storage with 1,900 Terabytes of contiguous space and began migrating data from the legacy data into the newly provisioned space during the fall of 2022. The new storage solution also accomplished the first step in creating a common filesystem technology with the High-Performance Computing (HPC) ecosystem. Although the containing data centers are separated by 75 miles, the goal became to continue to increase the technical commonality wherever possible, despite the disparate origins of the clusters.

BENEFITS REALIZED

• Investigators with large data collections are no longer limited to 10 TB segments; they can now more easily continue their research and expand their datastore.

• LPC Cluster users on the new storage are no longer interrupted by shuffling data sets between storage pools once they meet their storage maximum.

• HPC storage technology was adopted for the LPC cluster, giving better cross-data center standards, bringing standardization across the two environments.

• Accumulated cost recovery funds collected from service agreements were leveraged to provide the new storage solution.

• Implementation of the new storage solution did not increase the charge-back rates, as the solution was planned and negotiated to fall within the limit of funds available.

Penn Medicine’s Administrative Business System (Pennfor) Launches New Modules: Support Talent Acquisition, Transition Management, Qualifications, Compensation

BACKGROUND DESCRIPTION

Penn Medicine’s new cloud-based human capital management system supports a variety of human resources, operations, and workforce functions. This project continues to implement its HR transformation initiative enabled by the new Pennfor Enterprise Resource Platform (ERP) deployment. This project phase includes the integration of multiple systems into Pennfor to allow for seamless integration of the talent acquisition functions, enhance the candidate recruiting experience, improve management of employee lifecycle processes, automate the management of clinical qualification verifications, and support the administration of key compensation programs.

BENEFITS REALIZED

• Maximize PennforPeople as a single system to recruit, develop, and retain talent (job boards, communications with candidates while decommissioning standalone Talent Acquisition system.

• Modernize and standardize business processes and entity specific workflows.

• Eliminate manual processes, offline data repositories, and redundancies through automation.

• Create real-time information, to be used as a single source of truth.

• Increase efficiencies and reduce data entry burden for front line managers with manual tracking of HR related data.

• Enhance regulatory compliance and patient safety; reduce UPHS’ risk via automated license/ certification verification.

• Fully populate staff qualifications to facilitate talent development and succession.

• Enable employees to build and manage their profiles in PennforPeople.

• Enhanced reporting, analytics, and access to HR data.

• Develop standard HR metrics (recruitment and onboarding volume, processes and outcomes, identifying inefficiencies and triggering operational tactics).

SAVINGS QUALITATIVE

BENEFITS CATEGORY

DIGITALLY ENABLED HEALTHCARE

These projects are focused on implementation and enhancement of the electronic health record applications in which clinical documentation is captured and used to support patient care delivery. Mobile health and patient engagement tools are also represented.

2022 $24,142,140

2023

$4,343,040

$7,754,808

TOTAL $93,090,577

Projects are reported for fiscal years 2022 and 2023.

Projected financial benefits from projects completed in prior years are displayed in the thirteen-year summary on page 75.

Penn Medicine at Home Merger Expands Home Care Services, Integrated Technology Aligns Care

BACKGROUND DESCRIPTION

The merger of Horizon Healthcare Services with Penn Home Infusion Therapy (PHIT) created an additional home infusion location which allowed Penn Medicine at Home to expand their infusion therapy services to patients in the Lancaster, PA region. The integration included all aspects of information services, specifically the creation and expansion of functionality of CPR+, adding the location to the telecommunications network, setting up UPHS network and security access in the Lancaster location, purchasing new equipment, creating a support model for site staff post go-live, EHR system provisioning in both UPHS and LGH instances, and the rebuilding of a specialty program called PAWS. The PAWS program provided pharmacists and technicians with visibility of the workload in the pharmacy. This provided process transparency that ensured resource availability to prepare and deliver patient medications in a timely manner.

The integration allowed each location to use a common software platform for seamless communication between staff members at both locations. Additionally, having two home infusion locations operating on the same software enabled easy access for updating patient information in one system and ensured compliance with regulations and standardizations of practices for all Penn Medicine patients receiving home infusion. Overall, the merger has been a positive change, allowing for improved communication, efficiency, and quality of care for patients receiving home infusion therapy services.

BENEFITS REALIZED

• Introduction of more specialty medications in the Lancaster region.

• One consistent approach to home infusion patient care.

• Utilization of Public Health Service Act section 340B, introducing discounted medications to the Lancaster region.

• Increase in gross margin, resulting in $35 million in new revenue.

• Increase in cost savings by the elimination of redundant roles.

$35,000,000

$30,000,000

$25,000,000

$20,000,000

$15,000,000

$10,000,000

$5,000,000

BACKGROUND DESCRIPTION

In radiation therapy, a directed energy beam of x-rays is used to cause DNA damage to cells in a tumor, with the intention of causing gradual cell death in the tumor. Because x-rays travel completely through the body and impact all cells in the path of the beam (including those in front of and behind the tumor), one of the primary challenges with radiation therapy is avoiding or minimizing the impact of x-rays on adjacent tissues that are sensitive to high doses of x-ray energy. Traditional techniques include adjusting the shape of the beam or the path it takes through the body or adjusting the daily dose of radiation to an amount where daily collateral damage to healthy tissue can be repaired overnight between treatments (cancer cells lack this DNA repair mechanism).

However, radiation treatment in some parts of the body may involve unavoidable complications and side effects, and proton therapy can have an important accuracy advantage for treatment of these cancers. Unlike a conventional x-ray treatment beam that does not have a defined end point, a proton beam typically only travels 15-20 cm once emitted from the treatment machine, and nearly all the energy is deposited at this terminal focal point, allowing the radiation team to better avoid problem areas in the body and reduce the incidence and severity of treatment-related side effects.

Lancaster General Health shares two important firsts in the healthcare industry concerning this therapy:

• First in the world to go live on the next generation of all-digital proton machines. Staff and engineers from across the country moved to Lancaster to use the best of the best.

• First satellite proton therapy center in the world, supported by a proton planning team and radiation information system based at the Perelman Center for Advanced Medicine (PCAM).

A key component of this initiative was to integrate the proton equipment into the existing Lancaster General Health Ann B. Barshinger Cancer Institute information technology (IT) infrastructure to ensure a smooth patient and provider experience in delivering proton therapy. Information Services (IS) worked closely with the design and construction teams and the vendor to ensure appropriate configuration of the wired and wireless network, ports, firewalls and IP addresses. The network and cybersecurity teams also partnered with one another to ensure proper data flow from the consul computers connected to the proton machines to the oncology information system servers.

From an application and integration standpoint, an IS Process Engineer worked with LGH operations along with the IS Radiation Oncology, eHealth, and integration teams to map out current and future state workflows that would ultimately assist with defining the application and integration technology build. In all, the teams configured the oncology system, eHealth (EHR) and interfaces to accommodate referrals, orders, appointment scheduling, results, coding and billing.

Additionally, the IS Applications and Telecommunications teams supported the rollout of two key communications and collaboration systems with this initiative. The communications systems ensure reliable, secure, and functional VoIP calling, texting, paging and broadcasts. They also allow escalation of critical notifications to team members – enabling clinical and non-clinical staff to collaborate on patient-related care all from a single user interface. The nurse call collaboration system enables efficiency and responsiveness of staff by facilitating direct communication between patient and provider.

BENEFITS REALIZED

As a result of patient volumes being more complex than anticipated and with a better payer mix and better payment rates, revenue has been higher than anticipated. Over the next 5 years, Penn Medicine projects over $20,500,100 in new revenue:

• Year 1: $1,279,900

• Years 2 – 3: $7,378,500

• Years 4 – 5: $11,841,700

$25,000,000

$20,000,000

$15,000,000

$10,000,000 $5,000,000

Technology Outfitted to Support New Gift of Life Donor Center

BACKGROUND DESCRIPTION

In September 2022, Penn Medicine established a dedicated clinical space to be shared with the Gift of Life program staff to receive donors and harvest organs. Establishing this new satellite location enabled Gift of Life transplant coordinators to orchestrate the full lifecycle of a patient donor and provided a dedicated ICU unit to manage the intake of donors in advance of their donation. The objective of locating the donor center within our flagship hospital was to improve the clinical management of donors and increase the number of organs recovered per donor to benefit all transplants recipients within 1500 miles of the Hospital of the University of Pennsylvania, including the Penn Medicine Transplant program.

New EHR technology solutions and unique configurations were put into place to maintain data privacy and classification of the donors while standardizing their admissions and billing processes. Customized order sets were built to manage patient flow from entry into our doors, movement to the ICU unit, to the OR, and finally to the morgue. The Penn E’lert patient monitoring system was also installed for virtual monitoring of patients on life support. Additional new technologies were added to perform livestream video and video storage regarding assessing organ viability by providers outside Penn Medicine. These features allowed other transplant centers to perform organ quality reviews by the remote teams which enabled transplant surgeons from other medical centers to view the donor organs before harvesting to support organ acceptance.

With this new clinical program space, time was reduced to gain organ acceptance and the number of organs accepted increased, to maximize the donor's gift. Previously, surgeons often turned down organs if test results were questionable, but in many cases the organ is deemed usable when reviewed visually. The video system enabled visible inspection of the organ while still being perfused, giving transplant surgeons the confidence to accept the organ.

BENEFITS REALIZED

Donor Care Center Impact

September 2022 - June 2024

Research Organs Pancreas Transplant

249 Total Organs

19 Total Pancreas / 8 Stayed at HUP

Heart Transplants Lung Transplants

85 Total Hearts / 9 Stayed at HUP

126 Total Lungs / 21 Stayed at HUP

Liver Transplant Kidney Transplants

232 Total Livers / 46 Stayed at HUP 404 Total Kidneys / 33 Stayed at HUP

• This hospital-based model assisted with donor optimization and organ recovery from brain dead donors by centralizing resources to improve efficiency and increase the level of care.

• Increased access to critical organs resulted in the transplant of almost 900 organs including hearts, lungs, livers, kidneys and pancreases.

• By significantly gaining the ability to harvest more organs, physicians had much more opportunity to save additional lives.

• The more efficient clinical space also resulted in additional revenue of $13.96 million from the increased volume.

• Historically, HUP averaged 20 donors per year, however with this new dedicated space, the volume of donors increased 10-fold!

• HUP experienced a 594% increase in deceased donor activity the first year they opened the doors to the donor care center.

$13,960,000

$14,000,000

$12,000,000

$10,000,000

$8,000,000

$6,000,000

$4,000,000

$2,000,000

Lancaster General Health Introduces Medication Management Clinics to the Region

BACKGROUND DESCRIPTION

A new pharmacy medication management clinic was designed and launched in Lancaster, Pa to help expand service to patients in the regional area and increase the percentage of prescriptions that qualify for 340B at Lancaster General Health. Public Health Service Act section 340B requires Medicaid participating pharmaceutical manufacturers to make outpatient drugs available at discounted prices to health care organizations that care for many uninsured and low-income patients. The initial clinic was introduced to offer patients an encounter with a pharmacist to provide a thorough medication management review, education session, clinical review, and an opportunity to identify the most cost-effective way for patients to obtain medications.

In support of this initiative, the eHealth application team created new technology features in the EHR to support pharmacist driven medication access and education at the clinics. A new LGH department was built along with a clinic referral order as well as billing and claims development. To facilitate ease of placing medication orders, EHR build included updates to medication records, physician ordering preference lists, treatment, and support care plans, and note documentation templates containing features to quickly complete a patient note.

The technology build in the EHR allowed providers to easily select the new service, obtain medication and diagnosis information at the pharmacy clinic, and enabled billing. A letter was also created to send to eligible patients explaining the Penn Medicine/LGH Specialty Pharmacy Program and to help them with the enrollment process. The clinic has shown to significantly improve clinical outcomes and patient compliance. As a result, LGH now has four clinics in the regional area since the initial site was launched.

BENEFITS REALIZED

The purpose of these clinics was to conduct a patient education and medication therapy management visit in hospital licensed space. As such, the clinics needed to be built to allow the pharmacists to function as a provider and drop appropriate coding to have the visit considered as an eligible encounter for 340B program qualification.

• The pharmacy conducted over 75 medication education visits/week among two sites.

• Pharmacists averaged over one intervention per patient visit – for each patient seen in the clinic.

• Pharmacy used medication access visits to assist patients with using financial assistance program for medication copays, saving patients over $300,000 in out-of-pocket copays per month.

• Additional 340B savings from pharmacist medication access visits generated over $6 million in additional net revenue in FY 22/23.

• Over the next 5 years, growth is expected as we increase utilization of the existing clinics and add additional clinics, specifically one in the suburban outpatient pavilion in FY25.

• Over the next 5 years as we add clinics and resources, we project growing by an additional $4 million, bringing the total revenue to $10 million in net revenue.

$10,000,000

$8,000,000

$6,000,000

$4,000,000

$2,000,000

Pioneering CAR-T at Lancaster General Health, Delivering Groundbreaking Outpatient Cancer Therapy

BACKGROUND DESCRIPTION

As with other forms of cancer therapy, one key challenge with drug-based therapies is the side effects that patients can suffer from treatment. Unlike surgery and radiation therapy that can be deployed to specific areas, chemotherapy can affect regions far beyond the location of the tumor. CAR-T uses technology developed by Penn Medicine to train the body’s own immune cells to recognize cancer cells by tiny differences in their presentation and communication versus other cells in the body, so that they can be targeted and destroyed. Modifying the DNA of the immune cells to find cancer cells requires complex work in a special bio lab. At present, these therapies are limited to blood cancers but will soon expand to solid tumors such as breast and lung cancer.

Given the experimental nature of the therapy, these treatments were initially restricted to patients that already tried and failed several other treatments. As such, life expectancy is limited and there is typically no other choice available. Even in this scenario, CAR-T therapy has shown success rates where 75% or more of patients experience a complete response lasting at least 18-months.

IMPORTANT MILESTONES

• LGH was the first community hospital in the world to administer CAR-T therapy to a sub-population of advanced lymphoma patients.

• LGH is the first hospital in the world to develop an outpatient CAR-T program, and 100% of treatments have been outpatient. Other hospitals typically have most of their patients treated in the inpatient setting.

• LGH developed the first written process for CAR-T that comprehensively addressed everything from patient selection and clearance to initiating care and responding to side effects and reactions.

• New lymphoma CAR-T is being added to expand treatment volume to 15 patients per year, and a myeloma product after that which would apply to about 50-100 patients a year at LGH.

• Significant interest from industry in partnering with LGH after its initial experience with lymphoma.

• Based on the work that the LGH Information Services team did on the pathway, as well as our large program size, LGH’s role in Penn Medicine’s CAR-T program will be the test site for new therapies before they go outpatient and before they spread to other Penn Medicine hospitals.

A CAR-T program leadership steering committee was developed in addition to smaller working groups which included Oncology, Pharmacy, Laboratory, Blood Bank, Revenue Cycle, Quality, Emergency Services, Critical Care, Project Management and Information Services. We worked hand in hand with the Penn Medicine Cellular Therapy team to develop future state workflows, create clinical documentation tools and operational policies and procedures. Information Services used the EHR application’s foundation tools to help create documentation tools for all of the staff involved in the patient’s CAR-T journey to document directly in the EHR and not on paper. This includes CAR-T Oncology Treatment Plans, a CAR-T checklist for the coordinators to track their tasks, a CAR-T smart note template to assist with CIBMTR reporting, flowsheets for infusion documentation and charge capture and ED and Critical Care order sets for toxicity management. We also partnered with the New York Blood Bank to have them come and perform the leukapheresis cell harvesting procedure for our patients and subsequent cryopreservation of the cells as they further develop the engineering process.

Pioneering CAR-T at Lancaster General Health, Delivering Groundbreaking Outpatient Cancer Therapy (Continued)

BENEFITS REALIZED

• LGH’s ability to offer CAR-T treatment in an outpatient setting, as well as recently renegotiated contracts for a new CAR-T product, is expected to realize $5,986,300 in new revenue over the next 5 years.

• Penn Medicine is aiming to commercialize intellectual property as the therapy services are expanded to solid tumors, such as breast and lung cancer.

• Enhanced patient care: Our friends in Penn Medicine’s downtown CAR-T program recognize that there is a sizeable population in Lancaster that will consider CAR-T but would not consider leaving town for this treatment, so it is important to spread access of this technology to other centers.

• Other NCI institutions are keeping those patients in the hospital for at least a week, and sometimes two weeks.

• They also have to stay within 30 minutes of the NCI center for at least 30 days, or up to 90 days. Those are both substantial impositions on a family.

$6,000,000

$5,000,000

$4,000,000

$3,000,000

$2,000,000

$1,000,000

New High Sensitivity Troponin Biomarker Standard Leads to Better Patient Care

BACKGROUND DESCRIPTION

The American Heart Association (AHA) and American College of Cardiology (ACC) guidelines in 2021 indicated that, “high-sensitivity cardiac troponins (hs-cTn) are the preferred standard for establishing a biomarker diagnosis of acute myocardial infarction. Following the guideline allows for more accurate detection and exclusion of myocardial injury” in the evaluation and diagnosis of chest pain or its angina equivalents. Using hs-cTn allows for earlier rule out while reducing rates of missed myocardial infarction. However, it can also be elevated in patients without ischemic disease. So, instead of relying on a single value and a reference range, proper use requires evaluation within the clinical context and interpretation of interval changes relative to presentation. Some testing results require followup, potentially in a wide range of outpatient practice settings. For example, patients with diabetes, hypertension, and cancer would not historically have had an elevated baseline troponin but may have had it with high sensitivity troponin. An elevated baseline troponin may then increase the complexity of their management and complicate decisions about the cardiac impact of treatments.

This paradigm shift, both in workflow and interpretation, presented a large educational, logistical, and implementation challenge. In benchmarking with peers such as Duke, Mass General Brigham, and University of Texas Southwestern, we learned that there were significant risks of diagnostic errors, inappropriate admissions, more cardiology consults, unnecessary imaging, delayed discharges from the ED, and/or delayed outpatient follow-up. Two of our hospitals (LGH and CCH) were using this biomarker, but the remaining five were not. While seeking to fully transition to the hs-cTn standard, a challenge was identified with the variation in infrastructure. Hs-cTn is run on large analyzers in the core laboratories and not all laboratories have the same equipment. Harmonization of equipment would involve prohibitive large capital purchases and construction.

The project to pursue this shift was a highly collaborative process, engaging physician, nursing, laboratory, informatics, and operational leadership. Clinical experts, referencing existing troponin pathways, and taking into consideration different clinical workflows within the Health System worked with informatics experts to build the troponin care pathway. This pathway was then modified to fit different clinical settings including the Emergency Department, outpatient offices and inpatient teams. Every potential user then needed targeted education on the impact to their area.

High sensitivity troponin is a marker of early cardiac injury and may also be elevated in conditions such as cancer, diabetes, end stage renal disease, and hypertension. Given the prevalence of these conditions, nearly every provider in the health system was affected by the deployment of the cardiac troponin pathway (approximately 8,000 individuals).

The following achievements demonstrate the actions our organization took to support this transition:

• Formed an interdisciplinary, enterprise-wide governance, eventually including 89 participants.

• Designed algorithms based upon research and embedded these in care pathways, with logic optimized for individual workflows and collaboration.

• Developed a site for reference and links to needed clinical materials.

• Coordinated the launch with all remaining labs and analyzers.

• Instituted a variety of educational efforts to inform and prepare care givers.

• Coordinated communication plan for impacted groups.

• Supported a command center to address questions and concerns.

• Created an electronic dashboard for continuous monitoring.

BENEFITS REALIZED

• The initiative was successfully launched in June 2022, with a very smooth transition from the old assay to new high sensitivity troponin with no reporting of diagnostic error, inappropriate admission, or increase in cardiology consultation. In fact, implementation of hs-cTn decreased ED length of stay.

• Patients with a chief complaint of chest pain had a 26% decrease in median percentage of observation dispositions.

• Patients with a chief complaint of chest pain or shortness of breath:

• 13% increase in median percentage of discharge disposition.

• 17% decrease in median percentage of observation dispositions.

• • Increased diagnosis of NSTEMI and STEMI for patients presenting with chief complaint of chest pain.

• • Stable ED length of stay for patients presenting with chief complaint of chest pain.

• • The precision of using high sensitivity troponin helped reduce ED length of stay (LOS), resulting in an average reduction of 71-minutes for admitted cardiac patients and a 24-minute reduction for those discharged.

• Based on the volume of cardiac patients and those receiving troponin treatment in the ED, Penn Medicine realized over $3.9 million in savings through reduced LOS. Reduction in length of stay not only improved patient throughput, but also increased ED capacity, potentially allowing for an increased number of patients treated.

• Quicker patient turnover led to better resource utilization.

• This project met Penn Medicine’s team goal aligning to the organization’s blueprint for quality and patient safety strategies particularly for continuity of care, high reliability and innovation.

$4,000,000

$3,000,000

$2,000,000

$1,000,000

Princeton Medical Center Lab Integration with Enterprise System

BACKGROUND DESCRIPTION

The Penn Medicine Princeton Health (PMPH) lab system joined the downtown hospitals’ lab IS system, integrating to a single instance of the application, thus becoming fully unified on the Penn Medicine corporate applications. This project moved PMPH from a large and impactful separate instance of the legacy application into one fully integrated lab among the four hospitals. This system-wide integration at PMPH established a robust and scalable foundation for both financial sustainability and operational excellence across Penn Medicine’s laboratory services.

BENEFITS REALIZED

FINANCIAL BENEFITS

• By incorporating our Princeton medical facility into the single instance of the lab system already used by other Penn Medicine facilities, the organization realized $59,040 in cost savings in FY23, and projected avoidance is as follows:

• $335,384 in FY24

• $367,124 in FY25

• $372,781 in FY26

• $378,608 in FY27

QUALITATIVE BENEFITS

• The integration of PMPH into Penn Medicine’s enterprise lab system delivered qualitative improvements, which directly enhanced operational reliability, patient safety, and system-wide collaboration.

• Risk Mitigation: By transitioning PMPH to the enterprise system, the risk of an unrecoverable system failure was aligned with that of the downtown system. The consolidated system also reduces potential for data discrepancies or errors between two previously isolated systems.

• Improved Vendor Support: Centralizing the system offered IS more streamlined and effective support from the vendor.

• Consistent Lab IS Technology Management: Integrating PMPH into the broader system ensured that the application and hardware are maintained at consistent patch levels across the entire organization. This standardization leads to enhanced security, system stability, and ease of updates.

• Enhanced Collaboration: The project fostered greater IS collaboration between PMPH and the downtown hospitals.

• Operational Efficiency: The centralized lab system simplified the support model and maintenance of the system, leading to more efficient use of IS resources.

• Scalability for Future Growth: The unified lab system sets a foundation for future growth and scaling across Penn Medicine. As the health system expands, the ability to onboard new facilities and integrate them into the existing lab infrastructure could be much easier. Given our implementation of local hospital testing/instrumentation, additional efforts for system harmonization are set as upcoming goals to pursue full scalability.

$2,000,000

$1,500,000

$1,000,000

$500,000

Enhancements to the ICU Board Improve Clinical Workflow and Prompt Patient Centered

Care

BACKGROUND DESCRIPTION

Our Medical Critical Care and Respiratory Care department has used an electronic ICU board to monitor the status of ICU patients in real-time and prompt providers when action is needed – for example, when a patient is ready to be removed from mechanical ventilation. Information Services’ Application Development team recognized the need for a more stable and reliable platform to support the application. The team evaluated and decided that the best approach was to internally develop the solution, having the application development team rewrite the back-end components of the ICU Board, eliminating reliance on the previous system and its components.

The rewrite incorporated direct data feeds from our electronic health record, which significantly improved the timeliness of information provided to clinicians. This has enabled clinicians to respond more quickly, since the patients’ ventilator and tracheotomy status are now more accurate, timely, and transparent.

Our development team also incorporated the ability to further address the patient experience. A nudge was implemented on the ICU Board to prompt the care team to consult speech services on the third day after a suction aide tracheotomy was placed. The development and implementation of this nudge represents our commitment to continuous improvement and patient-centered care.

BENEFITS REALIZED

• Cost Savings: The removal of the previous platform eliminated the need for an additional database product which resulted in a cost saving of $250,000 per year.

• $50,000 per year for the software licensing fee.

• $200,000 per year related to application hosting costs for hardware, storage, backup, and virtual machines.

• Enhanced Stability: Since the rewrite, the ICU Board has operated without system failures, providing clinicians with a stable, robust, and reliable tool to support their pulmonary care tasks.

• Risk Mitigation: The removal of the previous platform mitigated the risk associated with using unsupported software components.

• Time Savings: Reduced time required by software engineers to identify and resolve prior system performance issues.

• Patient Care: The rewrite resulted in more timely data being delivered to the ICU Board, potentially resulting in improved patient care.

• Patient Experience: The implementation of the nudge on the ICU Board that reminds clinicians to consult speech services is indicative of our commitment to enhanced patient experience.

$1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000

$200,000

Specialty Injections Pharmacy Designed to Help Facilitate Patient Care Continuity

BACKGROUND DESCRIPTION

A variety of specialty injections are prescribed across several outpatient disciplines at Penn Medicine, targeting chronic and complex conditions such as autoimmune diseases, cancer, migraines, and osteoporosis. Administering these high-cost, highly specialized medications presented challenges for the clinics due to the complexity of prior authorizations and reimbursement processes. For example, specialty injections often require prior authorizations from insurance companies to ensure coverage, as the cost per dose can be significant. This process involves verifying that the patient meets specific criteria, such as a particular diagnosis or failed response to other treatments. Without proper prior authorization, the cost of the medication might not be reimbursed, leading to financial strain for both the patient and the healthcare provider.

To enhance patient care continuity, a project was initiated to streamline the administration of these medications while also optimizing revenue generation. This goal required collaboration across multiple departments, including pharmacy operations, finance, patient accounting, revenue operations, accounts receivable, training, regulatory, and various EHR application teams.

The system-wide project was initiated in May 2022 and went live at Penn Presbyterian Medical Center (PPMC) in April 2023. Project objectives changed directions several times due to various regulatory and compliance complexities, however, the ultimate solution resulted in the build of a new practice in the EHR, dedicated to Pharmacy performing prior authorizations, scheduling patients, and administering the injections. This required significant process reengineering and communication/coordination between Pharmacy, Finance, and the referring practices.

BENEFITS REALIZED

The Pharmacy Injection Clinic went live in April 2023, inside the Infusion suite at Penn Presbyterian Medical Center. A patient room was uniquely reserved for pharmacy use. Initially, the focus was on one specialty injection to ensure the processes, and the reimbursements worked as designed under controlled circumstances. As of May 2024, PPMC Pharmacy is planning for expansion and administration of more medications. When the practice was built in the EHR, fourteen medications were initially built to be used for dispensing and administration.

• Enhanced Patient Satisfaction: Offering “one-stop shopping” within Penn Medicine, reducing the need for patients to travel elsewhere for treatment.

• Improved Physician Satisfaction: Physicians appreciated the improved coordination and communication across disciplines, as patients no longer needed to be referred outside the Penn Medicine network.

• Process Optimization: Centralized authorization, scheduling, and administration streamlined operations, reducing bottlenecks and improving workflow efficiency.

• In-House Patient Care: Retaining the administration of specialty medications within the Penn Medicine system enhanced patient care and continuity.

• Successful Financial Outcomes: 55 patients were seen, and $2 million was billed within the first 8 months of operation resulting in over $800,000 in new revenue .

• Clinic Expansion: The clinic has expanded from administering one medication once a week to administering multiple medications across multiple clinic sessions.

• Future Growth: Potential expansion of this model to other entities in the near future.

A Focus on Physician Wellness, Using Technology to Reduce Clinical Decision Support Alert Noise

BACKGROUND DESCRIPTION

The five rights of clinical decision support (CDS) is a framework designed to deliver the right information to the right people, in the right format, through the right channels, at the right points in the workflow. Penn Medicine has established a robust CDS governance group to evaluate and recommend all CDS tools, such as alerts, banners, and order sets, within the electronic health record (EHR). A key issue identified was the lack of a mechanism or process to improve or remove CDS tools when they were later assessed as low value postimplementation of the ED module of the EHR.

Defining standards for EHR tools ensures consistency in the build, design, and implementation of CDS tools. Alert management programs must strive to meet common goals of improving patient care while simultaneously decreasing the alert burden on clinicians. Clinician cognitive fatigue and apathy related to the overuse of alarming colors, banners, and EHR alerts was identified in the ED module of the EHR. When clinicians are inundated with too many alerts and system triggers, it becomes difficult for them to prioritize, leading to a feeling that when everything is important, nothing is truly important.

At Penn Medicine, a multidisciplinary group comprising informaticians, operations leads, IS managers, and technical leads developed guidelines for CDS tools in the EHR. These guidelines now ensure that CDS tools are evaluated upfront for purpose and focus. The guidelines also define the meaning of colors, how and when alerts and banners should be resolved, and to whom they should and should not appear, all while creating actionable and meaningful alerts and banners. As a result, the EHR Wellness component of CDS will be extended to other domains within the EHR.

BENEFITS REALIZED

A total of 36 user instances of CDS tools in the ED module of the EHR were identified to review: 26 banners and 10 interruptive alerts. The 26 banners were reviewed by the multi-disciplinary team and 5 were selected for removal, while 5 needed major modification including updating color schemes thus creating more actionable measures for the clinician. Of the 10 interruptive alerts that were evaluated, 7 were decommissioned and 1 was modified to reduce the alert burden. Of the 7 alerts that were identified to be eliminated, users had a projected reduction in over 600,000 annual triggers.

• Improved clinician efficiency and workflow by reducing the number of interruptive alerts; helped to streamline clinicians’ workflow, allowing them to focus more on patient care.

• The time saved through the reduction of interruptive alerts represents a substantial productivity improvement equivalent to a financial value of $20,700 per year, or $103,500 over 5 years.

• Eliminating unnecessary alerts saved the nursing team an average of 450 hours throughout the year.

• Reduced alert fatigue and empowered clinicians to act more effectively on the alerts received.

• Activation of Best Practice Advisory (BPA) user feedback tool enabled the clinician’s voice to be heard directly at the time of the alert.

• Enhanced clinical decision support led to increased adoption and satisfaction with the EHR.

Strategic Streamlining of Virus Panel Testing in the ED Optimizes Clinical Decision Support

BACKGROUND DESCRIPTION

Patients who have come to the Emergency Department during wintertime typically have a routine testing panel performed to detect respiratory illnesses such as COVID-19, the flu, and RSV (Respiratory Syncytial Virus). Based on seasonality, appropriate clinical leaders make determinations and adjustments of necessary testing requirements, especially when these viruses tend to rise. During the winter of 2023, the HUP emergency department began conducting rapid COVID-19 combination tests, with 85% being STAT orders. Given the volume and turnaround time, the laboratory aimed to reduce the number of these rapid STAT tests to improve overall clinical workflow and reduce the unnecessary burdensome costs derived from these tests.

A team of laboratory professionals, ED physicians, informatics, and information services staff developed an updated COVID/FLU/RSV testing panel to prioritize routine testing options and specify necessary indications for STAT testing. This new testing panel was more effective than the previous panel and was able to help identify patients who still required additional screening. Penn Medicine was able to avoid unnecessary testing that could result in clinical false positives due to long term viral shedding.

The integration of these new decision support order panels has played a crucial role in reducing respiratory virus and more specifically COVID-19 STAT testing in the Emergency Department at HUP. These panels have provided guidance to clinicians and streamlined the clinical process of evaluating patients with COVID-19 symptoms.

BENEFITS REALIZED

Implementing a routine clinical decision support testing panel for use in the ED helped designate respiratory virus in patients while significantly reducing the number of STAT COVID-19 tests ordered.

• RESULTS:

• Pilot Pre-Week: 85% of all COVID-19 tests were STAT, totaling 667 tests.

• Pilot Post-Week: Approximately 50% of all COVID-19 tests were STAT, totaling 310 tests.

• Over the two full weeks of the pilot, there was a 53.52% reduction in STAT COVID-19 testing from the HUP Emergency Department (ED).

• COST SAVINGS:

• Over the course of one quarter, we measured the financial impact of the order panel. The reduction of unnecessary STAT tests lead to a savings of $66,300, while COVID-19 screenings were required.

$70,000

$60,000

$50,000

Universal Suicide Risk Screening EHR Workflow Assists in Positive Patient Care Outcomes

BACKGROUND DESCRIPTION

The Joint Commission released a national patient safety goal to reduce the risk of suicide using an evidence-based tool for suicide risk screening and assessments. An interdisciplinary group including behavioral health experts, IS Inpatient and Ambulatory teams, providers, nurses, social work, and regulatory representatives formed to assess and expand the Columbia-Suicide Severity Rating Scale (C-SSRS) evidence-based tool in the ambulatory and behavioral health settings. Regulatory requirements indicated that suicide risk screening only be required for behavioral health conditions. Despite the requirement being limited to specific diagnoses, the group’s overwhelming response was to universally screen patients for suicide risk given the rise in suicide attempts locally and nationally.

The project was approached in two phases. The initial phase focused on building the nurse-driven universal screening tool, which went live in our EHR in September 2020. Phase two addressed the remaining requirements for suicide risk assessment completion by the provider or a trained clinician. The C-SSRS suicide risk assessment was built with a clinical decision support (CDS) workflow designed for: increased visibility to view the data, order set enhancements for required suicide precautions, continuous observation orders, and diet order updates, along with reminders for and ongoing reassessment and documentation completion with direct documentation links. The new EHR functionality made the workflow seamless for caregiver assessment and completion.

The suicide risk assessment went live in November 2021. Continued enhancements to the workflow have occurred from clinical feedback and ongoing regulatory requirements made through 2023. Overall goals achieved were a standardized workflow across applications with shared data for improved reporting and documentation, which allowed for improved continuity of care and increased safety for patients at suicide risk. Also, the workflow designed for the Emergency Department ensured that a patient in the ED does not get discharged without a screening assessment, if triggered.

Lastly, health system policy updates occurred to reflect the change to C-SSRS and streamlined wording for the assessment process. A care plan was developed along with patient education, which auto-adds to the chart from a positive screening. A group of nurse leaders formed to create an education module, based on regulatory requirements, and successfully implemented a module in June 2022. The module was adapted for inpatient, emergency department, behavioral health, ambulatory, and home health.

BENEFITS REALIZED

• Standardized the workflow for using the evidence-based C-SSRS tools across all EHR applications, allowing for efficient documentation.

• Drove collaboration between IS, operational, and content experts leading to clinical adoption of the workflows.

• Maximized use of the best EHR and Clinical Decision Support tools:

• Actionable banners provided better visibility, direction, and guidance for clinicians.

• Interruptive Best Practice Alert (BPA) reduction.

• Shared flowsheet rows among encounters and applications for clinician documentation.

• Flowsheet rows designed to trigger and show data in a linear assessment over time.

• Improved care delivery and patient safety due to consistent procedure, training, and monitoring of suicide risk documentation.

• An example for use at Penn Presbyterian Medical Center ED showed demonstrates improved suicide risk assessment documentation compliance from 30% to over 90%.

LiveAware Platform Uses Natural Language Processing to Improve Clinical Outcomes for Hepatocellular Carcinoma (HCC)

BACKGROUND DESCRIPTION

At Penn Medicine, we diagnose and treat patients with hepatocellular carcinoma (HCC), a type of liver cancer with 5-year survival rates of 3-36%. The American Association for the Study of Liver Diseases (AASLD) recommends that patients at risk for HCC undergo a screening abdominal ultrasound every 6 months. However, a study by King et al. published in the World Journal of Hepatology acknowledged that adherence to HCC screening guidelines is low, ranging from 12-18% of at-risk patients, but as high as 52% in at-risk patients followed by hepatologists (GIs). The data at Penn Medicine are similar: adherence to recommended screening intervals varies significantly across our Health System, from approximately 60% of patients followed by GIs to 15-25% of patients followed only by primary care (PCPs). We also observed that once patients had a signed order for screening, more than 70% of them completed their screening. This was our opportunity to intervene by using a novel platform incorporating natural language processing to assist with identifying patients in need of HCC screening!

LiveAware Platform Uses Natural Language Processing to Improve Clinical Outcomes for Hepatocellular Carcinoma (HCC) (Continued)

There are many steps between recognizing a patient’s eligibility for a screening study and the patient successfully completing the screening examination. These steps are the source of the cognitive burden on our clinical colleagues, who are already busy caring for patients with multiple other pressing issues and may not realize that the patient is at risk for HCC and should be screened. With these factors in mind, our team in the Center for Practice Transformation in Radiology (CPX) developed LiveAware. LiveAware is not a commercial product; rather, it is a Penn Medicine service to increase rates of imaging-based screening.

We first developed and validated a query to access the data in different parts of the PennChart EHR that would help us determine risk status and screening eligibility. Since most of these patients were not getting screened according to the recommended timeline, creating an order for screening increased the likelihood of completing a screening. So, our team built a pipeline to identify patients with an upcoming PCP visit and attach a temporary order to the encounter in the EHR. Upon opening the encounter, the PCP sees a pop-up alerting them to the pended order and offering options to open or cancel the order. The order nudges the PCP to let them know that LiveAware has determined that the patient is not only at risk for HCC but overdue for the recommended 6-month screening ultrasound.

The pilot implementation focused on improving rates of HCC screening for the nearly 10,000 active Penn Medicine patients at risk for HCC. We also evaluated LiveAware with 11 PCPs from a single practice in our Primary Care Service Line. Twenty-three at-risk patients who were due for screening were identified during the 1-month pilot. 82% of the pended orders placed were signed, which represented a significant increase over even the most optimistic rate of 60% we observed in our baseline data. Beyond the success of these pilots, we onboarded 7 downtown Philadelphia Penn Medicine Primary Care practices during the first year of the program. In 2023, we finished onboarding the Philadelphia region for primary care service line clinics.

BENEFITS REALIZED

Because LiveAware is a platform, not a solution for a single use case, it can be expanded to other applications. As of April 2024, several departments have shown notable positive results in their metrics compared to the initial baseline data from January 1, 2019.

• The Division of General Internal Medicine (DGIM) increased its order signing rate to 49.4, an 8-point improvement.

• DGIM Cooper also saw a rise, with 45.8% of orders signed, up by 5.6 points.

• Similarly, DGIM PPMC improved its order signing rate to 43.6%, an increase of 8 points.

• In University City, Penn Family Care exhibited significant gains, with their orders signed rising to 45.1%, an 18-point improvement, and patient adherence to recommended screening (ultrasound every 6 months) increasing to 25.1%, up by 5 points.

• Presbyterian Medical Associates also showed strong results, with orders signed increasing to 45.8% (+16 points) and patient adherence improving to 27.1% (+8 points).

• Delancey Rittenhouse saw their order signing rate climb to 43.9%, a 4-point increase.

• Delancey Washington demonstrated a substantial rise in orders signed, reaching 37.2% (+13 points), along with an improvement in patient adherence, which increased to 22.3% (+3 points).

• These remarkable improvements highlight the significant strides made in both order signing rates and patient adherence to recommended screening protocols across departments.

LiveAware benefits individual patients, their clinicians, and even payors. We can set patients up for better outcomes when their cancers are found and treated earlier, saving them from enduring multiple procedures, facing limited treatment options, and experiencing the untimely loss of life associated with a late-stage cancer diagnosis.

• Liveware touches more patients and replaces manual, time-consuming tasks that are inefficient and delay patient care.

• It has the potential to get more patients screened on time, which leads to more cancers diagnosed earlier and fewer requirements for costly therapies for advanced stage disease.

• We can improve quality of life while decreasing the total cost of care for large numbers of patients.

Electronic Health Record Modifications Improve ED Admission and Inpatient Bed Management

BACKGROUND DESCRIPTION

The COVID-19 virus brought substantially increased demand into the Emergency Department (ED) at the Hospital of the University of Pennsylvania (HUP). Like many facilities in the nation, the HUP ED and inpatient patient care settings became strained with ED overcrowding, ED boarding, and overflow of patient care delivery in inpatient units. To address these issues, we identified process interventions and electronic health record (EHR) technology build modifications that would help streamline the patient flow process from the ED to the inpatient floor.

The project generated the following EHR build modifications that provided multiple care teams (Bed Management, Case Management, Social Work, ED Providers, ED Nurses, and Inpatient Nurses) with enhanced visibility into the patient’s status and care progression while in the Emergency Department.

• EHR notification was built to signal to Bed Management when inpatient criteria review was completed by Case Management / Social Work and notify of inpatient discharge cancellation.

• A new ‘Likely to Admit’ admission order and flag was created in the EHR to prioritize those patients for Case Management review and Bed Management placement. The flag provided advance notification to the care teams of a patient’s likely admission to an inpatient bed.

• Development of a patient ‘Incoming List by Specialty.’ This list was made available in the EHR, listing incoming patient admittances with an accepting care team assigned.

• Built a Provider Team Capacity dashboard to track either when provider teams are near or at capacity, replacing a paper process. The lists are dynamically updated with changes in provider coverages, easing the on-call rotation process.

BENEFITS REALIZED

• Process flow improvements were noted with the new admission order ‘Likely to Admit’.

• The bed assignment time (from Bed Request to Bed Assignment) decreased by 1 hour and 15 minutes when the ‘Likely to Admit’ order was used.

• The overall time spent in the ED (time of ED arrival to floor arrival time) decreased by 1 hour and 14 minutes when the ‘Likely to Admit’ order was used.

• The Likely to Admit order along with the added EHR notifications, Provider Team Capacity dashboard, and an Incoming Patient Admission listing by specialty has provided enhanced transparency to patient throughput and progression especially during peak capacity timeframes.

Lead-Free Families Program Targets

Community Health Initiative at Lancaster General Health

BACKGROUND DESCRIPTION

It is estimated that about 91,000 Lancaster County homes have lead hazards, often from lead-based paint. This region has one of the highest rates of elevated blood lead levels in Pennsylvania as well as one of the lowest screening rates in the state, making lead exposure and poisoning a significant health issue for children. As such, Lancaster County ranks one of the highest in Pennsylvania to advocate for lead poisoned kids.

That is why Penn Medicine Lancaster General Health launched “Lead-Free Families;” a comprehensive program aimed at creating a strong pathway to eliminate childhood lead poisoning in Lancaster County. Lead-Free Families is the first such program in the United States to be 100-percent funded and led by a health system as a commitment to making the community a healthier place for all people. The IS telecommunications team developed a complex telecommunications campaign, which was launched in 2022, including features for outreach such as email, SMS, voice, and other custom tools with the goal of increasing screening rates throughout the Health System. The campaign provided outreach, reminder messaging, and phone calls to parents of young patients, with a lead order that did not result in the EHR.

Lead-Free Families aims at increasing screening rates and lowering the percentage of children under the age of 6 identified with high lead levels. Lead-Free Families has set a goal of identifying and remediating lead hazards in at least 2,800 Lancaster County homes over the next 10 years, while also providing community education and support services for families.

BENEFITS REALIZED

• Created a report in the EHR of children who had elevated blood lead levels for program members to contact and enroll families to make their home safe from lead hazards.

• This referral process was enabled by EHR workflows to provide patients with education and program information between the provider and the Lead-Free Family program.

• To date, 329 children have been assisted who had been lead poisoned. Consequently, the number of children with increased lead levels has dropped by 50% due to the program’s measures for outreach, education, testing, technology supporting program workflows, and lead remediation within affected areas.

• Efforts to Outcome (ETO) software was integrated with the EHR to simplify and automate the measurement of the effectiveness of the program. Without this integration, the measurement and process were manual and time intensive.

Lancaster General Health Food Farmacy Program Raises Nutrition Based Population Health Outcomes

BACKGROUND DESCRIPTION

Penn Medicine Lancaster General Health (LGH) developed a community program to help address barriers to healthy eating for foodinsecure individuals and families. The Food is Medicine-Food Farmacy program works in partnership with local food pantries to provide nutritional food and integrates closely with patients’ health care providers while also incorporating registered dietitians into the care team. The program focuses on adult patients who live in Lancaster County and have nutrition-related chronic disease like prediabetes, diabetes, or metabolic syndrome, and are at risk for food insecurity.

Patients who are referred by their LGH PCP or specialist meet with a dietitian at a food pantry near their home. During Food Farmacy appointments, dietitians provide food-insecure patients with nutrition counseling and healthy food for them and their families to help manage their nutrition-related chronic diseases. Services are scheduled in the electronic health record (EHR) and are free of charge to patients.

The Food Farmacy program relies on our EHR to allow providers across LGH practices and specialties to refer patients to the program, thus allowing for efficient referral review, intake, and scheduling. Through the EHR, our team reviews eligibility, contacts the patient, schedules labs, and coordinates the first program visit. Throughout the duration of the one-year program, dietitians consistently document in the electronic health record regarding visit activities and outcomes. In support of this new system usage, the Information Services e-Health team built a new department, revenue location, visit types, scheduling resource, registration workflows, modified the referral process and set up the appointment reminder system and patient letter system.

Additionally, the EHR content build design includes a dashboard, integrates smart forms for pre and post assessment as well as other documentation tools for program evaluation. The pre and post assessments help staff identify patient progress and follow-up needs. These assessments were created for patients to complete through the online patient portal, saving staff valuable time collecting this information. Discrete patient data collected from the smart forms and the episode of care encounter can be accessed from automated EHR reporting tools.

BENEFITS REALIZED

• EHR visit documentation allows for consistency in nutrition counseling, coordination and communication with the care team, patient progress monitoring, and goal tracking.

• Since mid-2023, the program has served 380 patients and over 800 family members. A total of 70 individuals have completed 12 months of services and graduated from the program.

• The program has distributed a total of 38,826 pounds of healthy food since it began.

• Among the patients who have completed the program, 60% of the graduates reported increased confidence in their nutrition skills, 73% reported improved healthy eating habits, and 49% reported decreased food insecurity.

• These behavior changes have also led to measurable changes in health outcomes. Overall, 66% of the graduates had improved blood pressure, 71% decreased waist circumference, 59% experienced weight loss, 56% improved hemoglobin A1c, 62% improved triglycerides, and 60% improved HDL cholesterol.

We have received positive feedback from providers, patients, and our community partners since the program began. In addition to our program outcome data, we receive positive feedback from patients about the most important ways that the program has impacted them. Some of our recent patient experiences include:

• A patient thought foods like oatmeal, cereal, and pasta were bad for her and would cause excess weight gain. Her dietitian explained that these foods are an important part of a healthy diet. She left the appointment so excited to eat oatmeal the next morning for breakfast!

• A patient began encouraging her granddaughter to eat healthy snacks like rice cakes with peanut butter and to go on walks with her.

• A complex patient diagnosed with irritable bowel syndrome, addiction, anxiety, and an eating disorder said, “I always leave here feeling better than I did before I came.” She told us, “Everyone should be able to receive nutrition counseling and food assistance if they need it.”

Program efficiency and success have led to successful program implementation and an award-winning program as recognized by the Hospital and Health System Association of PA’s, highest honor - The 2024 Living the Vision Award.

SAVINGS QUALITATIVE

Patient Statin Adherence Improved by Leveraging New Technology Features

BACKGROUND DESCRIPTION

Statins have been known to substantially reduce cardiovascular risk, yet adherence from patients has been sub-optimal. For example, 90-day prescription fills have been consistently associated with better adherence than 30-day fills, though many prescriptions were not written for 90 days. As a result, we evaluated the effect of changing default prescription length to 90 days on the proportion of statin prescriptions written for 90 days.

We analyzed the proportion of prescriptions written using the primary care preference list for a 90-day supply for the four months before and after the change using a chi-square test, along with need to change prescription dose or drug during the 90-day time period, a potential unintended consequence. By modifying the primary care service line EHR preference list default option and modifying the system-wide EHR database default option we brought this intervention to full Health System scale. Next, we analyzed the n (%) of all statin prescriptions in the EHR for a 90-day supply before and after the database change and compared differences.

BENEFITS REALIZED

Primary Care Preference List Change: There were 8,884 total prescriptions analyzed, of which 4,021 were written before the preference list change and afterward 4,863. Overall, 65.4% were for white patients, 19.8% for black patients, and 14.0% of patients of other race; 34.9% were for Medicare patients, 5.9% for Medicaid patients, and 58.4% for patients with commercial insurance; 21.1% of the population lived in neighborhoods with a median income less than $50,000.

• The rate of prescriptions written for 90 days increased from 70.6% before the default change to 90.1% post-intervention.

• Pre-intervention, patients with Medicaid insurance, median ZIP code household income less than $50,000, and black race were much less likely to be prescribed a 90-day statin supply.

• The intervention increased the proportion of 90-day prescriptions more in these groups and they were no longer less likely to be prescribed a 90-day supply in the post-intervention period, and black patients were more likely to be prescribed a 90-day supply than other race groups.

• Post-intervention, there was no change in the proportion of patients that needed a change in prescription during the active prescription time period.

• Changing default preference list options in the EHR was associated with a significant increase in the proportion of statin prescriptions written for 90 days and a closure of baseline equity gaps without restricting physician or patient choice.

Penn Medicine Database change: There were 212,337 total prescriptions analyzed, of which 182,385 were written before the preference list change and afterward 133,137.

• The rate of prescriptions written for 90-days increased from 85.9% before the default change to 88.8% post-intervention.

• This change resulted in a net increase of 4,100 statin prescriptions for a 90-day supply per year, helping Penn Medicine improve quality of care, decrease barriers to adherence, and also meet value-based payment metrics for medication adherence as measured by medication fills.

• 90-day defaults were also turned on for hypertension and diabetes medications.

Can Improve Equity

BENEFITS CATEGORY MAKING DATA MEANINGFUL

These projects are focused on effective capture and use of data from the clinical and financial systems to support improved care delivery, financial management, and quality improvement.

2022 $35,000

2023

2024

2025

$2,432,185

$2,635,188

$2,637,688

2026 $2,637,688

2027

$2,595,188

TOTAL $12,972,937

Projects are reported for fiscal years 2022 and 2023.

Projected financial benefits from projects completed in prior years are displayed in the thirteen-year summary on page 75.

Penn Medicine’s Primary Care Network Expands through Tandigm Health

BACKGROUND DESCRIPTION

Penn Medicine has reinforced its commitment to value-based care by integrating its primary care network with Tandigm Health, (a population health services organization), in partnership with Independence Blue Cross. This joint venture aims to improve patient outcomes, enhance care coordination, and control healthcare costs. The value-based care model, which prioritizes quality over quantity, has been a strategic focus in recent years, guiding the development and implementation of this innovative patient care approach.

During the first phase of implementation, several key technology objectives were successfully achieved:

• Data Integration: Established data flow between Penn Medicine’s electronic health record (EHR) system and the population health analytics vendor, improving the exchange of critical information across care teams.

• Comprehensive Patient Encounters: Enabled caregivers to access previously identified diagnoses and incorporate ongoing medical considerations into future care plans, supporting well-rounded patient care.

• Holistic Care Management: Developed technology that emphasizes past chronic diagnoses and future screening needs, enhancing chronic disease management and targeted care coordination.

• Patient-specific quality measures are displayed to guide preventive care and clinical interventions.

• Improved continuity of care during wellness encounters through more streamlined documentation processes.

• Population Health Workflows: Introduced new workflows within the EHR to support population health efforts, including riskbased chronic disease coding, patient referrals, and medical pathways.

• Collaborative Virtual Workspace: Created a joint virtual environment to facilitate real-time data sharing and collaboration during both the initial implementation phase and future projects.

BENEFITS REALIZED

• Streamlined EHR Workflows: Simplified processes in the EHR have made it easier for providers to complete annual comprehensive patient visits, improving both efficiency and care quality.

• Increased Reimbursements: In FY23, Penn Medicine Medical Group (PMMG) generated an additional $2,112,185 in reimbursements due to enhancements in the comprehensive visit process.

• Revenue Projections: From FY24 to FY27, the projected additional revenue is $2,595,188 (PPC = $2,085,500; CPUP = $509,688).

• Further Revenue Growth: Additional revenue is being generated from enhanced population health initiatives enabled by the Tandigm and Arcadia projects.

$14,000,000

$12,000,000

$10,000,000

$8,000,000

$6,000,000

$4,000,000

$2,000,000

$12,492,937

Penn Symphony Exam Room Software Makes Effective Use of Clinical Resource Management

BACKGROUND DESCRIPTION

Penn Symphony was built as a clinical operations management software platform to streamline daily administration of practice resources and provider schedules, while providing a comprehensive suite of analytical tools. The application was initially conceived from a desire to leverage technology to manage clinical operations within the Department of Ophthalmology at the University of Pennsylvania. Given that there were no existing software solutions available to effectively replace and enhance their paper-based system, developers in the ophthalmology department set out to build the system internally.

This centralized platform was designed to optimize patient scheduling, coordination, and allocation of exam rooms while providing easy access to accurate information and simplifying communication for providers and administrative staff. The design team built the application to layer various components of provider schedules to create a comprehensive picture of clinical operations. Once the application was ready to use, it immediately empowered practice and organization leaders to view the data and make well-informed, data-driven decisions regarding clinical resource utilization.

Since that time, Penn Symphony has undergone numerous iterations, with each new version adding functionality and further refining the methodology for building and managing schedules. As it has evolved, Penn Symphony has become a comprehensive system for managing physician schedules and exam room allocation, which allows administrators to truly harmonize clinical operations.

BENEFITS REALIZED

• Simplified communication for providers.

• Providers change requests and communications managed in one technology location.

• Removed manual processes such as email change requests, text messages, phone calls, verbal requests.

• Streamlined schedule coordination for administrators.

• Reduced manual, cumbersome spreadsheet room grid creations and emails.

• Created more transparency into overall room management for the practice, department, and entity to assist with growth planning and meeting patient demand.

• Improved room utilization.

• All exam room allocation and re-allocation assignments are managed in Penn Symphony to track exam room utilization.

• Strategic decision-making tool: aligned data to assist with growth and space planning.

In the Department of Ophthalmology’s initial pilot, enhanced room management technology has streamlined management of room allocation and reallocation along with provider scheduling management. It has also allowed us to make significant progress in the following key areas including:

• 48 clinical providers’ schedules positively impacted among 93 exam rooms across 5 locations.

• This translated to more patients being seen.

• 148 additional clinical sessions were added through Symphony (including Saturdays).

• ~$700,000 in charges were billed from additional sessions; totaling $280,000 in new revenue.

• ~14% increase in % of new patient visits (NPVs) seen within 10 days.

• >30 day decrease in rescheduling after provider-initiated cancellation.

• 65 support staff (ophthalmic technicians, photographers, and scribes) schedules were optimized.

• Significant reduction in time taken by staff to manage schedule changes from providers.

• Massive reduction in time spent creating support staff schedules.

• Provided complete transparency in all layers of clinical operation.

Building on the results achieved in the Department of Ophthalmology, Penn Symphony was rolled out in phases to all ambulatory departments. The rollouts completed in December 2023.

Penn Symphony Exam Room Software Makes Effective Use of Clinical Resource Management (Continued)

TESTIMONIALS

"I couldn’t imagine handling my recent physician recruitment without Symphony. It gave me a broad picture of where I have space capacity across my sites to look at. This helped lead to good discussions with necessary stakeholders and planning.

- Meredith Brady, DOO Ophthalmology

"Two of our ambulatory practices were approaching max capacity, undermining our ability to strategically grow. I leveraged the tool to indicate the spacing constraints we were facing and justified the need for the acquisition of an additional ambulatory practice.

- Joshua Roane, Admin of Practice Ops, Heart and Vascular PAH

"Previously I had to manage several, complex excel spread sheet room grids that were all over the place while managing a large multi-specialty shared practice. Symphony is much easier and gives me visibility into exam room space for multiple specialties at once. Much easier to assign and reallocate rooms.

- Valerie Subers, RN and Practice Operations Administrator for the multi-specialty practice at Penn Medicine Cherry Hill

$300,000

$250,000

$200,000

$150,000

$100,000

$50,000 $0

Cancer Registry Case Finder Application Creates Efficiencies for Case Finding and Reporting

BACKGROUND DESCRIPTION

For public health reasons, any healthcare medical center or office that diagnoses and/or treats oncology patients is required by law to report new cancer cases monthly to a central or state cancer registry. Although Penn Medicine uses a commercial third-party tool to collect and store our cancer registry data, we sought to cohesively identify, manage, and report on all the potential cancer cases from our large academic medical center in a more efficient way.

Penn Medicine’s Abramson Cancer Center consists of six hospitals, along with many clinical departments and divisions. Each month, 75,000100,000 encounters are generated which are related to the 30,000 - 35,000 unique patients being treated for or diagnosed with cancer. By building an in-house application to automate, organize, and manage this process, case finders are now empowered to better identify which patients qualify for inclusion in the registry. Without a commercially available solution to do this, we used the power of technology to internally design and transform the burdensome administrative workflow - automating a very manual, time consuming, and resource intensive process, which was often lagging. The application saves staff extensive time from doing manual case finding each month, just in management of current workflow by eliminating numerous Excel files and hundreds of emails. Case-finding is the first crucial piece in properly identifying reportable cancer cases for which to collect data. The Cancer Registry team spends approximately 29% of their time working on case-finding.

The application provides:

• Staff time efficiency, saving approximately 3-5 person-hours per month.

• Real-time data reporting, which decreases data delays.

• Analytics to assess appropriate staffing.

BENEFITS REALIZED

• Improved data quality.

• Available data for research.

Savings reflect both the efficiency gains and the anticipated growth in team size and responsibilities over the next five years. By leveraging the newly built in-house application, Penn Medicine expects to achieve significant time savings, resulting in financial savings amounting to $200,000:

• QUANTITATIVE SAVINGS:

• Year 1: $35,000 • Years 2-3: $80,000 • Years 4-5: $85,000

• QUALITATIVE SAVINGS:

• Automated Case Import: The app directly imports cases into the abstracting software, reducing manual data entry and minimizing human error.

• Decoupled from EHR and Cancer Registry Software: The app seamlessly works with any vendor’s product, even after switching Cancer Registry software vendors.

• Clear Patient Encounter Indication: Provides clear information on patient encounters at each institution.

• Efficient Processing: Allows case-finders to process encounters for multiple months at once, eliminating the need for monthly Excel lists.

• Data Consolidation and Formatting: Eliminates manual consolidation of Excel files, duplicate removal, and formatting for team use.

• Facility-Specific Focus: New ability to focus on specific facilities is especially helpful when reporting lags vary.

• Data Maintenance and Retrieval: Maintains all processed and pending data for easy retrieval.

• Enhanced Reporting Mechanisms: Provides new reporting options.

• Collaboration with Management: Allows users to share cases with management for assistance.

• Improved Workflow and User Satisfaction: User-friendly interface, intuitive design, and high user satisfaction.

AInSights Artificial Intelligence Platform Revolutionizes Disease Diagnostic Capabilities

BACKGROUND DESCRIPTION

Penn Medicine’s AInSights is a suite of new artificial intelligence (AI) tools for medical imaging, designed to improve early diagnosis of disease. By assembling a multi-disciplinary team of Penn Medicine experts to develop the platform and groundbreaking technology, Penn Medicine created an opportunity to identify and intercept disease before it progresses into a more substantial condition. By identifying disease at an earlier stage, the technology aims to reduce patient morbidity, mortality, and costs to the healthcare system.

AInSights was developed with the patient and physician as a central focus. Integrated with Penn Medicine’s fleet of imaging systems, the AI platform safeguards protected health data through data encryption for analysis in a high-performance cloud architecture environment. To ensure the interpretability of AI findings, physicians are fully “in-the loop” and can view results on their workstation. The team developed an interface to allow physicians to provide feedback to improve the AI technology. As an end-to-end platform, the long-term goal is to make more time for patient care and interpretation of clinical data. A unique aspect of the platform is that the AI models were developed using the Penn Medicine Biobank, a diverse population health research study.

The AI platform workflow begins after the radiology technologist completes the study and sends the images from the scanner to the Picture Archive and Communication System (PACS). Once the images have arrived in PACS, the radiologic technologist ends the study in the electronic health record and an order final HL7 message is sent to our Vendor Neutral Archive (VNA). The order final message triggers the VNA to send a command to PACS to move the study to the AI server. The AI system processes the images and outputs the AI images to PACS.

Our pilot program automatically reports hepatic and abdominal fat imaging phenotypes in CT exams, providing a detailed assessment from computed tomography. To demonstrate the benefit of Penn Medicine’s AInSights, the team has begun to look at changes in screening rates for disease and changes in clinical practice. As an example, over a five-month period in 2,383 imaging studies, the team assessed the incidence of an enlarged spleen, a condition that is often a sign of infection, cirrhosis, cancer and metabolic disease. This study found 7.5% of patients had an enlarged spleen. AI results were available within 3 minutes of completion of the imaging study, providing these insights immediately to doctors.

BENEFITS REALIZED

End-to-end technology was developed for the solution to support the AI pipeline workflow.

"Regarding the AI project innovation that the team developed, Mike Restuccia, senior vice president and chief information officer remarks that, “Presently, there is an enormous amount of hype associated with the potential impact of Artificial Intelligence to improve patient care. The collaborative Penn Medicine team embraced the hype and with technical skill and clinical excellence developed a deep learning, scalable and modular AI software platform to meet the clinical decision support medical imaging demands of the practice. This Penn Medicine team-based approach has turned hype into reality and generated significant benefits for our patients and caregivers." - Michael Restuccia, Senior Vice President and Chief Information Officer

Developed by a multi-expert team at Penn Medicine, the platform automates analysis of medical imaging data, providing precision medicine clinical-decision support to the practice of radiology for complex diseases such as diabetes and Alzheimer’s disease. A longterm goal is to provide quantitative clinical insights to physicians, improving the care of patients. Due to the at-scale analysis of large daily volumes of imaging studies, the AI workflow costs less than one dollar per patient in computing and storage costs. The following initial benefits have been realized because of this project:

• New Diagnoses: AInSights has contributed to new diagnoses. AI analysis was successfully completed on 2,383 studies. Elevated liver fat was identified in 7.2% of patients scanned. Additionally, 7.5% of patients were found to have radiologically determined splenomegaly. This directly influenced patient management by identifying conditions that require further medical assessment.

• Impact on Treatment: The AI system's ability to quantify changes like hippocampal volume influences treatment decisions for conditions such as Alzheimer’s, facilitating early and potentially more effective interventions.

• Operational Efficiency: Integrating AInSights has improved radiologists' efficiency by reducing the time needed to analyze imaging studies. This helps reduce healthcare costs and increase the throughput of radiological assessments.

• Improved Community Health and Reduced Healthcare Expenditures: Long-term benefits are far more impactful as early appropriate management and mitigation results in lower overall morbidity, which can be less expensive than end-stage care.

BENEFITS CATEGORY

MAKING THE CONNECTION

These projects are focused on using technology to enhance the communication and sharing of information between providers and patients across the continuum of care. 2022

Projects are reported for fiscal years 2022 and 2023.

Projected financial benefits from projects completed in prior years are displayed in the thirteen-year summary on page 75.

New Infant Feeding Application Facilitates Efficiencies in the Penn Medicine NICUs

BACKGROUND DESCRIPTION

An enterprise-wide technology solution was sought to support infant feeding management for the NICUs at PAH, HUP, and CCH, with the goal of ensuring newborn safety by preventing feeding-related errors while equipping staff with the most advanced technology available. This enterprise-wide approach and new technology solution offers safeguards against misadministration at every step of milk and formula management, while establishing consistent processes across the system. This reduces preparation and feeding errors and ensures reliable technical support.

The new system enabled the following benefits:

• More accurate feed preparation, using a built-in recipe calculator for formula/breast milk.

• Seamless EHR integration, with automated data flow and order validation.

• Optimized inventory and minimized waste, with supply and expiration insights.

• Best practice adherence, by tracking donor milk and human-milk-derived fortifiers.

• Effortless education delivery and patient resources for parents.

• Real-time insights on parents’ pumping activity and volumes, supporting proactive intervention.

• Encourages family participation in the child’s feeding plan, with supportive communication between lactation staff and families, including inventory notifications.

• Streamlines workflows through barcode scanning and easy-to-read labels, enabling efficient communication between care teams and families.

• Lower expenses on staff time, quality oversight, and error/risk mitigation, while reducing donor milk cost by supporting mother’s own milk production.

• Allows families to communicate directly with the healthcare providers, from the feeding application and families’ personal devices to seek assistance or discuss feeding problems.

• Centralized supported by Penn Medicine’s IS Managed Device Services (MDS) Team, which allows for coordinated and faster response times.

BENEFITS REALIZED

• Direct Software Maintenance Savings:

• By discontinuing the previous vendor support and contract, Penn Medicine realizes an annual cost savings of $366,800, or a total of $1,100,400 over the course of the three-year contract. Below is a summary by facility:

• PAH: $198,000 cost savings per year.

• HUP: $168,000 cost savings per year.

After successful implementation evaluation at PAH, Penn Medicine implemented the solution for other hospital nursery entities as an enterprise solution. Lower license costs were negotiated with the planned expansion into CCH in 2023, and the other Penn Medicine NICUs, if needed.

$1,200,000

Secure Texting Platform Integrates with EHR Application, Increases Patient Care Efficiency

BACKGROUND DESCRIPTION

Penn Medicine caregivers utilized a vendor supported secure messaging platform for efficient patient related communication. While the secure messaging platform was used among selected frontline staff, its usage was limited in all care settings, particularly in areas such as emergency Departments, ORs, and Ambulatory settings.

Key clinical and IS leaders led the decision internally to integrate Penn Medicine into a unified texting solution through our EHR platform technology. Not only would this provide a system-wide texting framework for all caregivers to use together, but it would also integrate with our EHR. Having a unified secured messaging platform solution for all health system caregivers and staff provided the leverage to support and facilitate the adoption of the new tool.

BENEFITS REALIZED

• After an upfront investment of $237,600, switching to the EHR texting platform generated a cost savings of $167,456 annually.

• The switch from text solutions increased usage exponentially, from 17,618 users at the point of transition to 38,538 active accounts.

• Eased staff communication and simplified clinical workflows by adding features to the mobile devices and workstations already used.

• Removed clinicians’ need to switch between multiple applications to coordinate patient care.

• Secure HIPAA-compliant messaging became available to anyone with EHR access by desktop or mobile device, enabling users to quickly contact a patient’s care team members.

$600,000

$334,912

Iris Careboard and Outside Door Display Modernize Patient Experience in the HUP Pavilion

BACKGROUND DESCRIPTION

When Penn Medicine opened their new patient Pavilion in October of 2021, the facility became the newest part of the Hospital of the University of Pennsylvania in Philadelphia. The strategy behind the project began a decade earlier, formulating a plan to build a state of the art ‘hospital of the future’. By designing this new facility, we sought to apply new ways to deliver unprecedented care and elevate our patient and caregiver experiences using innovative and technologically advanced approaches.

Part of the vision for planning the facility’s features was to create a digital patient wall within each of the 504 inpatient rooms. The digital display was intended to serve as the IRIS — a focal point of care for both the patients and clinicians. IRIS was developed to connect an array of clinical and building management systems in ways never seen before in the inpatient care setting. In this modernized environment, the 75” display was built into each patient room and is used to control a part of the patient’s experience, which is meant to offer more of a hospitality feeling rather than a traditional hospital experience. Additionally, the integration of the digital display to clinical systems and staff was designed to improve patient care and provide a connection between the patient, the family, and the care providers of every specialty who entered the patient room. From the doctors and nurses to the therapists and social workers, to dietary and environmental service workers - all healthcare workers were considered to be integral to helping our patients feel like they are part of the care team to manage their care and get well again.

The Iris Careboard and Outside Door Display were designed and developed by a multifunctional team, including Nursing Informatics, IS Application Development, IS EHR team, and the low-voltage vendor for the HUP Pavilion. We accomplished the goals set by Penn Medicine leadership to use technology to make the HUP Pavilion a state-of-the-art facility, ensuring that our patients would benefit greatly from the experience. Patients and families would now be provided with information about their hospital stay in real time from the electronic health record (EHR) on the Careboard and Outside Door Display.

CAREBOARD CAPABILITIES:

• Displays key data elements for patients and families in plain language.

• Divides screen for the television function, the Careboard, and additional information on the bottom of the screen, including weather and who’s ‘In my room’.

• Includes photos of the patient’s care team, risks, goals for the day, diet, and discharge information.

• Replaces the traditional physical whiteboard.

• Updates automatically, in real-time from the electronic health records system.

OUTSIDE DOOR DISPLAY CAPABILITIES:

• Precautions for visitors and caregivers to take before entering the room.

• Identifies the nurse and clinical nursing assistant assigned to the room.

• Replaces a collection of laminated signs hung outside each patient door.

• Patients and caregivers can view additional precautions at the touch of a button.

While we were not the first hospital to build a digital whiteboard, our experience of building a unique solution from the ground up allowed us to ensure that the content was exactly what we needed for patient care. Patient and family advisors were part of the project team, guiding the decision making. Our IRIS Careboard and Outside Door Display were both one of a kind and we have continuously improved them. Beyond FY23, we optimized and expanded the IRIS capabilities into the Emergency Department and at other Penn Medicine hospitals, allowing us to begin collecting key metrics like length of stay and throughput.

Our newest technology developed for the Pavilion, Codeboard went live in September 2023. A patient specific Codeboard and digital clock were designed to appear alongside a two-way video from our Center of Connected Care clinicians. When this code call is activated on the nurses system in the room, the content includes the most recent vitals, labs, and contact information for the covering providers. The Center for Connected Care appears virtually as an added support prior to the CODE team's arrival.

Iris Careboard and Outside Door Display Modernize Patient Experience in the HUP (Continued)

BENEFITS REALIZED

Since the Pavilion opened in October 2021 through fiscal year 2023, Iris has:

• Saved approximately 1,200 hours, resulting in $48,000 savings.

• Saved clinicians from manually hanging over 108,000 caution signs outside the rooms. This amounts to 600 to 1800 hours (about 2 and a half months) of time saved for nursing staff.

• Replaced the manual process of filling out a physical whiteboard for 41,000 patient admissions.

• Triggered notice of 5002 seizure events in the Epilepsy Monitoring Unit, initiating in-room automation.

• Triggered 944 code calls with integration of room environment, including virtual ICU response and Codeboard technology.

• Reduced nurse calls by enabling patients to adjust the lighting, temperature, and window blinds.

• Facilitated discussion between patient, patient’s family, and care team.

• Provided valuable tools for education and feedback.

$250,000

Patient Statement Process Redesign Optimizes Hospital and Professional Billing Services

BACKGROUND DESCRIPTION

The process used in the past for generating, printing, and mailing patient billing statements involved relying on an external business partner to design the images and graphics that accompany the patient visit information on the billing statements. The process involved multiple steps requiring file exchanges within the EHR and was costly, inefficient, and prone to production issues. To improve the process, a team from operations and Information Services came together to work with the vendor on streamlining the workflow to design a selfreliant, more efficient billing process.

The goal was to design the statement images directly in the EHR, using functionality contained from within the application to manage a new, optimized process. By leveraging the EHR's capabilities for statement processing, Penn Medicine increased independence from a third-party vendor to reduce costs and gain more control in how billing information would be presented to guarantors, thereby increasing satisfaction for patients, guarantors, and the billing office. Lancaster General Health was the first site that went live with the new personal/family statements in June 2023, with the rest of Penn Medicine adopting the process in January 2024.

BENEFITS REALIZED

• Reduced print vendor costs, realizing annual savings of over $30,000 from programming costs.

• Information Services crafted statement templates with input from Penn Medicine’s billing office and marketing team to send payment-related information to guarantors, while maintaining the flexibility of having a vendor print and mail the information.

• Template statements enhanced the guarantor experience in the patient portal.

• Customer service was improved by offering our users and patients quicker ways to view the same statement.

• Increased brand satisfaction by standardizing statement design throughout Penn Medicine.

• Expanded marketing options for physician affiliates by offering customized statements; this benefit was realized with PentaTandigm in April 2024.

$160,000

BENEFITS CATEGORY RESEARCH

These projects are focused on using data and technology solutions to support fundamental and discovery science clinical research at Penn Medicine's laboratories and hospitals to improve care for a wide range of medical conditions and provide the foundation for the next generation of therapies. The University of Pennsylvania encourages close collaboration between scientists and clinicians with the support of Information Services exemplified by its dozens of interdisciplinary clinical and research institutes, centers, and programs.

Using Technology Tools to Create Consistency and Streamline Research Data

BACKGROUND DESCRIPTION

As Penn Medicine acquired new medical practices into its network, their existing systems needed evaluation for integration into our corporate technology portfolio. In 2022, an initiative was launched to unify and better support research methods across the six hospital locations. One goal was to leverage our EHR system’s tools to operationalize a consistent and centralized research study activation, enrollment, and trial completion process. This initiative also sought to increase research participation across all hospitals, including Lancaster General Hospital, that uses its own EHR system instance.

Our EHR Research team and the Lancaster General Health E-Health team partnered with key leadership and resources from the Office of Clinical Research to streamline the EHR tools and processes across both EHR instances. The teams standardized the research module in both systems to use the same terminology and functionality, which had immediate utility and assistance with future integrations. The two IS teams also collaborated to include LGH in multiple funded research projects.

BENEFITS REALIZED

The standardization of the research modules in our EHR allows both hospitals to use the same Clinical Research Management System (CRMS), standardized both billing workflows and NCI reporting, and accurate enrollment metrics for research studies. This standardization also expands the amount of research opportunities that are available to patients by bringing in more trials overall, increases research growth, as well as increased research opportunities for patients and their families.

• Research study information resides in a unified platform.

• Privacy and data use are controlled by a centralized governance forum. Centralizing access and decision making around data access expectations are clearer and consistent.

• A focused group of individuals hears a consistent message about what can and cannot be shared in accordance with federal regulations, state laws, and Penn Medicine policy.

• One grant funded study based on EHR functionality launched at LGH, along with two more EHR research initiatives are set to launch in 2024.

• Access to research is improved and more consistent for patients. Penn Medicine patients from all medical locations will have access to trials throughout the health system.

• Expansion and growth of the research program on a centralized platform.

Penn Medicine’s BioBank Expands to Promote Increased Research Capabilities

BACKGROUND DESCRIPTION

The Penn Medicine BioBank (PMBB) has been working to significantly expand its size to increase both the number and diversity of samples available for research. Scaling up by using research-specific staff and specimen collection processes would have been costprohibitive, so Penn Medicine and PMBB focused on shifting to a model that leveraged the existing clinical infrastructure to expand its reach.

Our electronic health record (EHR) was previously configured to collect new research consents, and these new enhancements allowed PMBB clinical partners to place requests for research blood samples from consented patients using established clinical pathways. In addition, we automated mapping of specimens to patients and launched data integration in support of residual sample collection.

BENEFITS REALIZED

This project, which was the winner of the CIO 100 Award in 2022, has provided significant benefits to the Penn Medicine research community. Benefits resulted in an increase in the number of patients consented and a new capability to request and collect samples whose orders originated from clinical systems and settings. The ability to consent patients within the EHR was expanded among four hospitals in 2022, and as shown in the chart below, resulted in a large and sustained increase in the number of patients consented.

Total Patients by Month (YYYY-MM)

With respect to sample collections, PMBB gained these benefits:

• Data sharing was made available within PMBB. The PMBB analytics team needed to combine legacy data stored in a legacy database with new sample information stored in the LIMS. The LIMS team manages both systems and worked with database administrators to create database views that could be accessed by the PMBB team to search and combine data from the two systems. Prior to this, there was no way to work with the combined datasets. 20K

• Bulk order placement capability empowered PMBB clinicians to simply run a report in the EHR to identify consented patients with upcoming phlebotomy visits and place research blood draw orders for them in the clinical systems. This resulted in placing orders for about one hundred patients at a time.

• LIMS was integrated with clinical systems to permit matching a clinical barcode to a unique patient identifier to match the sample quickly and accurately to a patient. This was a time intensive, tedious process and it now happens each night with no manual intervention. It also enabled research bloods drawn in the clinic, to be scanned by the PMBB team, with the clinical barcode as part of the sample processing.

• In addition to receiving samples with clinical lab barcodes, LIMS was configured to receive EHR barcodes so that samples collected outside of the clinical lab system could still be automatically matched. Previously, this would have required manually recording a name, looking up the unique patient ID, and manually entering it into the LIMS.

• Datalink enrollments were configured in the EHR to support automatically enrolling consented patients into the PMBB research study in both the EHR and Clinical Research Management System. Enrollment is important for reporting purposes, and automating this step meant that the numbers are consistently up to date, which was much harder to achieve with manual steps as part of the process.

• In addition to specifically placed research blood draws, consented patients’ residual blood, which is blood no longer needed for clinical testing and ready for disposal, could now be sent to PMBB for processing. Enabling this process involved the LIMS team, data analytics team, and the clinical lab IS team. An automated process was created to send candidate clinical samples to the LIMS, which screens out patients who have already donated blood. Remaining samples then get sent to the clinical laboratory robotics system, which automatically pulls the samples prior to disposal. PMBB can then use their normal intake procedures set up for research blood draws to intake, process, and match the samples. As this process is optimized and rolled-out to more sites, the potential for a drastic increase in sample collections is possible. Prior to this configuration, this type of collection was not possible. It currently results in about six hundred samples/month collected.

Legacy Data Migrations to Lab Information Management System

BACKGROUND DESCRIPTION

As part of the research mission at Penn Medicine, biological specimens are collected and annotated to provide materials for future research that drive discoveries and new therapies. These samples and data are tracked for extended periods of time; historically, managed in either legacy systems or in spreadsheets resulting in data silos that limited sharing and integration with other data sources. Penn Medicine IS teams partnered with research laboratories to migrate this data out of these legacy systems into the enterprise Laboratory Information Management System, (LIMS), to provide a common, secure, supportable repository. This project is ongoing and has made considerable progress over the two-year period of this report.

BENEFITS REALIZED

Migrating to a centralized data management system for biobank samples offers several benefits. When the primary legacy system holding much of the data is retired, it will free up staff time, approximately 30% of an FTE, to focus on our current, centralized system. It will also eliminate several risks inherent in supporting legacy systems, including security concerns around older operating systems and a reduced ability to support the system due to limited knowledge and documentation.

For researchers, the benefits of using a more modern, centralized system resulted in improved data management. Data for all studies can be tracked in one system, samples that come from a collaborating lab can be pre-labeled and pre-annotated saving time and reducing errors, and research data can be combined with clinical data to link genetic markers or biomarkers to phenotype data.

Some specific metrics achieved during this period around legacy data migrations include:

• Data from 297 total research studies were migrated into the LIMS.

• 13,000 samples for 4 studies were migrated out of an in-house developed tracking system.

• Data for 268,000 samples was imported.

• Studies cannot be created in legacy systems, so with the data migrated to LIMS, legacy data and new study data can exist in a common system.

• Decanting studies from legacy systems will enable retirement of those older, difficult to maintain systems so staff can focus on common, current systems.

• Migrating from Excel to common systems guards against data loss and corruption.

• Retention of information about samples is captured in a central location.

• This is particularly important for future generations as researchers move on, so that future researchers do not have to recreate samples or re-perform analyses that were already conducted by previous lab members. In the past, this information was stored in paper notebooks and not easily accessible to others.

Using

BACKGROUND DESCRIPTION

The Institute for Immunology and Immune Health (I3H) was formed from the re-organization of the Institute for Immunology and the Immune Health Project which grew out of Penn Medicine’s COVID-19 response. The Lab Information Management System (LIMS) team started working with Immune Health on an emergency basis as part of the COVID-19 response when they helped the team label and track samples processed in the biosafety level 2+ processing rooms. Workflows to manage sample intake, processing, and freezer storage were stood up quickly, and eventually these processes were normalized and optimized to sustainably support laboratory operations.

The LIMS team partnered with Dr. John Wherry and the entire I3H team including clinical coordinators, the processing team, administrative staff, and the analytics team using the LIMS. The LIMS system now serves as the primary electronic data management tool for the group and for tracking information from the time of scheduling trial visits to sharing data with the analytics platform.

Finally, the LIMS team and I3H partnered with the Information Services Application Development team to create an iPhone application called SpeciTracker which is used by clinical coordinators to support at-home research sample collection. This is especially important in immunology research since specific timepoints are critical in understanding immune response. Also, it can be difficult for study participants to be present at a downtown hospital on the important days post infection or vaccination and home collections help to alleviate this challenge.

BENEFITS REALIZED

I3H has realized benefits across a wide spectrum of areas because of this project, which won a CIO 100 Award in 2023. Over the period in question, 24 research studies were launched, which included 2,700 participants with 150,000 samples tracked for them. In addition to just raw numbers, the processes that the lab now uses have been standardized and automated to allow researchers to focus on the science rather than data entry and administrative tasks.

Some specific examples include:

• Calendars showing upcoming visits and samples allow researchers to plan their day more efficiently and ease cross-team communication.

• Scalability on the tracking of dozens of studies, thousands of samples, multiple assay results, and the ability to reliably trace this back to the patient metadata is a top priority, which would not be possible without the LIMS.

• Collaboration with other labs allows samples to arrive to I3H already labeled and annotated, saving time and reducing errors.

• The laboratory estimates that the time needed to label samples has decreased from 13 hours to less than 1 hour, a savings of 12 person-hours. In addition, printed labels and storing the samples using barcode scanning has decreased from 8 to 2 hours.

• Capture of processing details and generation of derivative samples occurs automatically for easy annotation and barcoding.

• Dashboards quicky present actionable data to researchers based on their role.

• SpeciTracker iPhone app supports at-home research collections including communication back to the laboratory.

• Billing items are passively generated while processing and assays take place in the system, saving time by alleviating the need to go back later and itemize this work.

There was never a “before LIMS” period to quantify comparative results. That said, the laboratory started with four full-time resources doing processing. In the years since, they have added just two more FTEs, but the number of active studies, their complexity, and the types of activities have greatly increased. For example, the average number of unique types of visits increased from 7 at the end of 2020 to 35 at the end of FY2023. The lab estimates that an additional three FTEs and an additional –80C freezer would be required if they had to take on the sample management capabilities without the LIMS.

Substantial On-Going Savings and Cost Avoidance THIRTEEN YEAR LOOK

This is the fifth edition of the Information Services Benefits Realization Analysis. This edition features (48) high profile IS projects that were completed in fiscal years 2022 and 2023. This chart summarizes the cumulative new revenue, savings, and future cost avoidance associated with the IS projects features in the last thirteen years. It is evident that past IS activities continue to contribute to substantial return on investment to Penn Medicine. The contributions noted in this chart are reflective of the teamwork and collaboration between administration, clinical leadership, operations and Information Services.

ROLLING 13 YEAR BENEFITS REALIZATION (IN $ MILLIONS)

A Penn Medicine Information Services Publication http://www.pennmedicine.org/information-services/